Circulation, Vol 81, 91-100, Copyright © 1990 by American Heart Association
M Kuppermann, BR Luce, B McGovern, PJ Podrid, JT Bigger Jr and JN Ruskin
The automatic implantable defibrillator has been shown to decrease the
mortality of patients who have survived cardiac arrest due to ventricular
tachycardia or fibrillation and are at high risk for recurrence. We
performed a cost-effectiveness analysis of this seemingly expensive new
technology with data obtained from the 1984 Medicare data base, the medical
literature, Medicare carriers, individual pharmacies and hospitals, and
expert opinion. Analyzing combinations of principal and secondary discharge
diagnoses across 18 diagnosis-related groups, we estimated the cost of
hospitalization for a comparison group of patients. Hospitalization costs
for the defibrillator group were obtained from reported empirical data.
Rehospitalization rates and other health-care use estimates were solicited
from an expert panel of physicians, and mortality rates for both groups
were obtained from the literature. Using a decision- analytic model, we
estimated that the net cost effectiveness of the defibrillator, when used
in the high-risk patient, is approximately $17,100 per life-year saved,
with sensitivity analyses suggesting that the true value lies between
$15,000 and $25,000. This estimate is well within the range that is
currently accepted by the US medical care system for other life-saving
interventions. We also estimated the cost effectiveness of the
defibrillator in a 1991 scenario to be $7,400 per life-year saved, when the
device would have greater longevity, would be programmable, and would not
require a thoracotomy. Sensitivity analyses suggest that the true value
lies between a value that is cost saving (less expensive than pharmacologic
therapy) and $19,600 per life-year saved.
ARTICLES
An analysis of the cost effectiveness of the implantable defibrillator
Battelle Human Affairs Research Centers, Washington, DC.
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