Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT).

Abstract

BACKGROUND:

In the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), implantable cardioverter-defibrillator (ICD) therapy significantly reduced all-cause mortality rates compared with medical therapy alone in patients with stable, moderately symptomatic heart failure, whereas amiodarone had no benefit on mortality rates. We examined long-term economic implications of these results.

METHODS AND RESULTS:

Medical costs were estimated by using hospital billing data and the Medicare Fee Schedule. Our base case cost-effectiveness analysis used empirical clinical and cost data to estimate the lifetime incremental cost of saving an extra life-year with ICD therapy relative to medical therapy alone. At 5 years, the amiodarone arm had a survival rate equivalent to that of the placebo arm and higher costs than the placebo arm. For ICD relative to medical therapy alone, the base case lifetime cost-effectiveness and cost-utility ratios (discounted at 3%) were dollar 38,389 per life-year saved (LYS) and dollar 41,530 per quality-adjusted LYS, respectively. A cost-effectiveness ratio < dollar 100,000 was obtained in 99% of 1000 bootstrap repetitions. The cost-effectiveness ratio was sensitive to the amount of extrapolation beyond the empirical 5-year trial data: dollar 127,503 per LYS at 5 years, dollar 88,657 per LYS at 8 years, and dollar 58,510 per LYS at 12 years. Because of a significant interaction between ICD treatment and New York Heart Association class, the cost-effectiveness ratio was dollar 29,872 per LYS for class II, whereas there was incremental cost but no incremental benefit in class III.

CONCLUSIONS:

Prophylactic use of single-lead, shock-only ICD therapy is economically attractive in patients with stable, moderately symptomatic heart failure with an ejection fraction < or = 35%, particularly those in NYHA class II, as long as the benefits of ICD therapy observed in the SCD-HeFT persist for at least 8 years.

• Authors: Daniel B Mark, Charlotte L Nelson, Kevin J Anstrom, Sana M Al-Khatib, Anastasios A Tsiatis, Patricia A Cowper, Nancy E Clapp-Channing, Linda Davidson-Ray, Jeanne E Poole, George Johnson, Jill Anderson, Kerry L Lee, Gust H Bardy, SCD-HeFT Investigators
• Journal: Circulation (Circulation) Vol. 114 Issue 2 Pg. 135-42 (Jul 11 2006) ISSN: 1524-4539 [Electronic] United States
• PMID: 16818817 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Cost-Benefit Analysis
• Death, Sudden, Cardiac (epidemiology)
• Defibrillators, Implantable (economics)
• Electroshock
• Equipment Design
• Heart Failure (surgery)
• Humans
• Medical Records
• Randomized Controlled Trials as Topic (economics)
• Retrospective Studies
• Treatment Outcome
• United States (epidemiology)