Otten's presentation will show how, just at the U-M center alone, 140 patients over three years would theoretically have qualified for an ICD under MADIT-II criteria, regardless of their QRS score. That's 10 percent of all patients with acute coronary syndromes (heart attack or unstable angina) treated at U-M in the three-year period.
But had those patients all tried to get coverage for an ICD under Medicare, 80 of them would have been denied under Medicare's current criteria, because their QRS score was too low.
"Assuming all the patients were under Medicare, that would have saved Medicare, and therefore society, $989,000 annually under current reimbursement rates," says Otten, a research fellow in the U-M Medical School's Department of Cardiovascular Medicine. If all 140 U-M patients received ICDs, the total cost would be about $1.73 million annually.
"But the savings would also come at the cost of about half of the sudden cardiac deaths that could be expected in the entire group," Otten continues. "That's because we found no difference in death or rehospitalization between those patients with a QRS interval less than 120 milliseconds, and those with a QRS interval greater than 120 milliseconds, when we checked in with them six months after hospitalization."
If all 140 patients had received an ICD, MADIT-II data suggest that their risk of a rhythm-related death would be 61 percent lower than if they had not received the device. In the conventional therapy, non-ICD arm of the MADIT-II study, 53 percent of the deaths were due to sudden cardiac death.
The U-M analysis estimates that approximately two of the 140 patients a year would be saved from sudden cardiac death if all the patients received an ICD. Even if some of the 140 patients died from non-rhythm-related causes, the net result would be that one person a year
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Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
9-Mar-2004