Cost-effectiveness of the implantable cardioverter-defibrillator versus antiarrhythmic drugs in survivors of serious ventricular tachyarrhythmias - Results of the Antiarrhythmics Versus Implantable Defibrillators (AVID) economic analysis substudy
Cost-effectiveness of the implantable cardioverter-defibrillator versus antiarrhythmic drugs in survivors of serious ventricular tachyarrhythmias - Results of the Antiarrhythmics Versus Implantable Defibrillators (AVID) economic analysis substudy
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DOI：
10.1161/01.cir.0000015504.57641.d0
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发表时间：
2002-04-30
期刊：
影响因子：
37.8
通讯作者：
Akiyama, T
中科院分区：
文献类型：
--
作者：
Larsen, G;Hallstrom, A;Akiyama, T
植入式心律转复除颤器（ICD）是一种有效但昂贵的设备。我们使用前瞻性收集的数据，从一个大型的随机临床试验的二级预防危及生命的室性心律失常，以确定成本效益的ICD相比，抗心律失常药物（AAD）治疗，主要与amiodarone.Methods和Results-Charges首次和重复住院，急诊室，手术日和抗心律失常药物的费用收集了1008例。收集了237名患者的所有其他医疗遭遇和费用的详细记录。然后创建回归模型，将这些费用归因于其余患者。使用标准方法将费用换算成1997年的费用。成本和使用寿命按每年3%的折扣。使用来自抗结核药与植入式去骨剂试验的三年生存数据计算基础病例成本-效果（C/E）比。还估计了6年、20年和终生的C/E比。三年了。使用AAD的患者总成本为71421美元，使用ICD的患者总成本为85522美元，ICD提供了0.21年的生存获益。因此，与AAD治疗相比，ICD每年挽救的生命的基础病例C/E比为66677美元（95% CI。30 761元至154 768元）。6年和20年的C/E比率保持稳定之间$68000和$80000每年的生命saved. Conclusions ICD是中等成本效益的二级预防危及生命的室性心律失常，判断前瞻性收集的数据在随机临床试验。
Background-The implantable cardioverter-defibrillator (ICD) is an effective but expensive device. We used prospectively collected data from a large randomized clinical trial of secondary prevention of life-threatening ventricular arrhythmias to determine the cost-effectiveness of the ICD compared with antiarrhythmic drug (AAD) therapy, largely with amiodarone.Methods and Results-Charges for initial and repeat hospitalizations, emergency room, and day surgery stays and the costs of antiarrhythmic drugs were collected on 1008 patients. Detailed records of all other medical encounters and expenses were collected on a subgroup of 237 patients. Regression models were then created to attribute these expenses to the rest of the patients. Charges were converted to 1997 costs using standard methods. Costs and life years were discounted at 3% per year. Three-year survival data from the Antiarrhythmics Versus Implantable Defibrillators trail were used to calculate the base-case cost-effectiveness (C/E) ratio. Six-year, twenty-year, and lifetime C/E ratios were also estimated. At 3 years. total costs were $71 421 for a patient taking AADs and $85 522 for a patient using an ICD, and the ICD provided a 0.21-year survival benefit over AAD treatment. The base-case C/E ratio was thus $66 677 per year of life saved by the ICD compared with AAD therapy (95% Cl. $30 761 to $154 768). Six- and 20-year C/E ratios remained stable between $68 000 and $80 000 per year of life saved.Conclusions-The ICD is moderately cost-effective for secondary prevention of life-threatening ventricular arrhythmias, as judged from prospectively collected data in a randomized clinical trial.