Abstract | BACKGROUND: OBJECTIVE: To compare the cost-effectiveness of primary prophylactic ICD vs. standard drug therapy for preventing CHF sudden death. DESIGN: Incremental Cost per Quality-Adjusted Life Year (QALY) using a lifetime decision model. DATA SOURCES: Estimates of cost, utility and probabilities from literature, clinical experts, CMS fee schedule payments, and the Bureau of Labor Statistics. TARGET POPULATION: U.S. CHF patients with NYHA functional Class II and III. TIME HORIZON: Lifetime; future values discounted at 3%. PERSPECTIVE: Societal. RESULTS OF BASE-CASE ANALYSIS: In 2002 prices the discounted lifetime cost is 122,947 dollars with primary prophylactic ICD and 25,223 dollars without ICD; the QALYs gained were 2.9031 and 1.9045 respectively. The incremental cost-effectiveness ratio was 97,861 dollars per QALY saved with prophylactic ICD. RESULTS OF SENSITIVITY ANALYSIS: ICD is not cost-effective under plausible scenarios using 50,000-80,000 dollars per QALY as the cost effectiveness threshold. The cost-effectiveness ratio is quite sensitive to patient utility after ICD implantation, and the proportion of CHF patients experiencing sudden death. CONCLUSIONS: Using a standard cost-effectiveness threshold and plausible parameter ranges, it is unlikely that ICD is cost-effectiveness in preventing CHF sudden death relative to standard drug therapy.
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Authors | Lei Chen, Joel W Hay |
Journal | Cardiovascular drugs and therapy
(Cardiovasc Drugs Ther)
Vol. 18
Issue 2
Pg. 161-70
(Mar 2004)
ISSN: 0920-3206 [Print] United States |
PMID | 15162078
(Publication Type: Journal Article)
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Topics |
- Comorbidity
- Cost-Benefit Analysis
- Death, Sudden, Cardiac
(etiology, prevention & control)
- Decision Making
- Defibrillators, Implantable
(economics)
- Economics, Pharmaceutical
- Heart Failure
(complications, economics, therapy)
- Humans
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