This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Stanton, M. S. Articles by Bell, G. K. Search for Related Content PubMed PubMed Citation Articles by Stanton, M. S. Articles by Bell, G. K. Related Collections Health policy and outcome research Ablation/ICD/surgery

(Circulation. 2000;101:1067.)
© 2000 American Heart Association, Inc.

Current Perspective

Economic Outcomes of Implantable Cardioverter-Defibrillators

Marshall S. Stanton, MD; Gregory K. Bell, PhD

From Medtronic Inc, Minneapolis, Minn, and Charles River Associates Inc, Boston, Mass (G.K.B.).

Background—We reviewed the literature pertaining to the cost-effectiveness of implantable cardioverter-defibrillator (ICD) therapy in the management of ventricular fibrillation and tachycardia. Discussed are the methodology, advantages, and limitations of economic-outcomes analyses as related to ICD therapy; the impact of new technology and physician practice patterns; and methodological recommendations for future studies.

Methods and Results—Articles published between 1990 and 1997 were screened for cost-effectiveness analyses of ICD versus antiarrhythmic drug therapy. Randomized clinical trials, prospective and retrospective studies, and economic models were included. These studies report incremental cost-effectiveness ratios ranging from cost savings of $13 975 per life-year saved (LYS) to an incremental cost of $114 917 per LYS for ICD therapy. Differences were due to study type, cost-reporting methodology, ICD technology used, and length of follow-up. Assuming current technology and physician practice patterns, we find that ICD total therapy costs may break even in 1 to 3 years.

Conclusions—Recent literature suggests that ICDs are a cost-effective therapy for management of life-threatening ventricular tachyarrhythmias. The advent of new technology and patient management practices should further improve the cost-effectiveness of ICD therapy. Future studies of ICD cost-effectiveness should address the implications of truncated follow-up periods and quality of life.

Key Words: cost-benefit analysis • cardioversion • defibrillation

This article has been cited by other articles:

				H. M. Spotnitz Surgical Implantation of Pacemakers and Automatic Defibrillators Card. Surg. Adult, January 1, 2008; 3(2008): 1395 - 1428. [Full Text]

				A. M. Feldman, G. de Lissovoy, M. R. Bristow, L. A. Saxon, T. De Marco, D. A. Kass, J. Boehmer, S. Singh, D. J. Whellan, P. Carson, et al. Cost Effectiveness of Cardiac Resynchronization Therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Trial J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2311 - 2321. [Abstract] [Full Text] [PDF]

				M. S. Stanton Implantable Cardioverter Defibrillators: An Excellent Case Study Health Aff., January 1, 2005; 24(1): 52 - 54. [Abstract] [Full Text] [PDF]

				H. M. Spotnitz Pacemakers and Automatic Defibrillators Card. Surg. Adult, January 1, 2003; 2(2003): 1293 - 1326. [Full Text]

				S. Nisam and J. Farre Is prophylaxis the best use of the ICD? Eur. Heart J., May 1, 2002; 23(9): 700 - 705. [Full Text] [PDF]

				D. V. Exner, G. J. Klein, and E. N. Prystowsky Primary Prevention of Sudden Death With Implantable Defibrillator Therapy in Patients With Cardiac Disease: Can We Afford to Do It? (Can We Afford Not To?) Circulation, September 25, 2001; 104(13): 1564 - 1570. [Full Text] [PDF]

				G Boriani, M Biffi, C Martignani, M Gallina, and A Branzi Cost-effectiveness of implantable cardioverter-defibrillators Eur. Heart J., June 2, 2001; 22(12): 990 - 996. [PDF]

				J. P. DiMarco Is programmed stimulation in survivors of myocardial infarction helpful? J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1908 - 1909. [Full Text] [PDF]

				A. Jaffe, W. M. Landau, R. D. Wetzel, W. J. Groh, M. E. Salive, L. D. Richardson, The Public Access Defibrillation Trial Investigato, R. E. Fried, M. Bassan, T. D. Valenzuela, et al. Automated External Defibrillators N. Engl. J. Med., March 8, 2001; 344(10): 771 - 773. [Full Text] [PDF]

				S. Nisam A Prophylactic ICD? Who are the patients? What is the device? Europace, January 1, 2001; 3(4): 269 - 274. [PDF]

				A.J Camm and S Nisam The Utilization of the Implantable Defibrillator--a European Enigma Eur. Heart J., December 2, 2000; 21(24): 1998 - 2004. [PDF]