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(Circulation. 2002;105:2049.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

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

Greg Larsen, MD; Alfred Hallstrom, PhD; John McAnulty, MD; Sergio Pinski, MD; Anna Olarte, MSc; Sean Sullivan, PhD; Michael Brodsky, MD; Judy Powell, BSN; Christy Marchant, RN, MBA; Cheryl Jennings; Toshio Akiyama, MD, PhD, the AVID Investigators

From the Cardiology Section (G.L.), Oregon VA Medical Center, Portland, Ore; AVID Clinical Trial Center and University of Washington (A.H., A.O., J.P.), Seattle, Wash; Division of Cardiology (J.H.M., C.M., G.L.), Oregon Health Sciences University, Portland, Oreg; Section of Cardiology (S.P.), Rush Medical College, Rush-Presbyterian-St Luke’s Medical Center, Chicago, Ill; Departments of Pharmacy and Health Services (S.S.), University of Washington, Seattle; Cardiology Department (M.B.), University of California-Irvine; National Heart, Lung and Blood Institute (C.J.), National Institutes of Health, Bethesda, Md; and Cardiology Department (T.A.), University of Rochester, NY.

Correspondence to Dr Larsen, Portland VA Medical Center, Cardiology Section P-3-CARD, 3710 SW US Veterans Hospital Road, Portland, OR 97201. E-mail greg.larsen{at}med.va.gov

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% CI, $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.

Key Words: cost-benefit analysis • heart arrest • antiarrhythmia agents • defibrillation • tachyarrhythmias

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