The cost-effectiveness of these potentially life-saving implantable cardioverter defibrillators (ICD) is an important public health issue, the researchers said, since the Centers for Medicare and Medicaid Services (CMS) estimates that as many as 500,000 of its patients could be eligible to receive these expensive devices.
The results of the team's analysis demonstrated that although expensive, in appropriate patients ICDs provide value. However, given the number of patients now eligible for ICD implantation, their analysis highlighted the need for further research into which patients are at higher risk for sudden cardiac death and therefore would benefit the most from this therapy, since the devices would be the most cost-effective for these patients, the researchers added.
ICDs are about the size of deck of cards and are surgically implanted under the skin of the chest, with wires attached to the heart. If the device senses a life-threatening irregularity of the heart rhythm, it delivers an appropriate electric impulse to bring the heart back into proper rhythm. ICDs have been proven effective in reducing sudden cardiac death in patients who had been resuscitated from a cardiac arrest, and the eight trials were designed to determine whether the devices could prevent sudden death in a healthier population of heart patients.
"Of the eight trials, two found no mortality benefits, so the use of an ICD was less effective and more expensive than for patients who did not receive an ICD," said Gillian
Contact: Richard Merritt
Duke University Medical Center