Implantable defibrillators cost-effective for preventing sudden death

collected on a subgroup of 237 patients, who were a balanced representation of the larger trial, geographically and medically.

We called these the shoebox patients, because we told them we wanted all their bills just bring them in a shoebox, says Larsen. The researchers converted the charges to 1997 costs. Three-year survival data from AVID were used to calculate the base cost effectiveness (C/E ratio). Six-year, 20-year and lifetime C/E ratios were also estimated.

The researchers determined that the largest expense for these patients is inpatient care, which makes up between 73 percent of total costs for drug therapy patients and 84 percent for ICD patients. At three years, the cost for the drug treatment group was $71,421. For the defibrillator group it was $85,522. The ICD provided a 0.21-year average survival benefit, putting the cost-effectiveness ratio at $66,677 per year of life saved.

The defibrillator patients lived longer, but they paid extra to get that extra life. The ratio of the additional amount paid for the additional survival benefit is the cost-effectiveness number, Larsen says.

According to Larsen, the conventional wisdom about cost-effectiveness ratios is that something is a bargain below about $50,000 per year of life saved, so the defibrillator is just on the margin of that bargain. Its on the high side but not out of reason.

The researchers also found that six- and 20-year C/E ratios remained stable between $68,000 and $80,000 per year of life saved.

This is only the beginning when it comes to cost-effectiveness studies on the devices, Larsen says. The cost effectiveness issue is going to be a very big part of the defibrillator story during the next year or two as more and more people look to ICDs for treatment.

For example, there may be changes in some of the big expenses from the ICD group, such as how often the ICD battery may need to be replaced, he says. At three

Contact: Carole Bullock
American Heart Association

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