on July 3, 2006
Circulation. 2006
Published online before print July 3, 2006, doi: 10.1161/CIRCULATIONAHA.105.581884
Published online before print July 3, 2006, doi: 10.1161/CIRCULATIONAHA.105.581884
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on August 9, 2005
From the Outcomes Research Group (D.B.M., K.J.A., P.A.C., N.C.C., L.D.R.), Duke Clinical Research Institute (K.L.L., C.L.N.); the Division of Cardiology, Department of Medicine, Duke University Medical Center (D.B.M., S.M.A.), Durham, NC; the Department of Statistics, North Carolina State University (A.A.T.), Raleigh, NC; The Seattle Institute for Cardiac Research (G.J., J.A., G.H.B.), Seattle, Wash; and The University of Washington Medical Center (G.H.B., J.E.P.), Seattle, Wash. * To whom correspondence should be addressed. E-mail: daniel.mark{at}duke.edu.
Background--In the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), implantable cardioverter-defibrillator (ICD) therapy significantly reduced all-cause mortality rates compared with medical therapy alone in patients with stable, moderately symptomatic heart failure, whereas amiodarone had no benefit on mortality rates. We examined long-term economic implications of these results. Methods and Results--Medical costs were estimated by using hospital billing data and the Medicare Fee Schedule. Our base case cost-effectiveness analysis used empirical clinical and cost data to estimate the lifetime incremental cost of saving an extra life-year with ICD therapy relative to medical therapy alone. At 5 years, the amiodarone arm had a survival rate equivalent to that of the placebo arm and higher costs than the placebo arm. For ICD relative to medical therapy alone, the base case lifetime cost-effectiveness and cost-utility ratios (discounted at 3%) were $38 389 per life-year saved (LYS) and $41 530 per quality-adjusted LYS, respectively. A cost-effectiveness ratio <$100 000 was obtained in 99% of 1000 bootstrap repetitions. The cost-effectiveness ratio was sensitive to the amount of extrapolation beyond the empirical 5-year trial data: $127 503 per LYS at 5 years, $88 657 per LYS at 8 years, and $58 510 per LYS at 12 years. Because of a significant interaction between ICD treatment and New York Heart Association class, the cost-effectiveness ratio was $29 872 per LYS for class II, whereas there was incremental cost but no incremental benefit in class III. Conclusions--Prophylactic use of single-lead, shock-only ICD therapy is economically attractive in patients with stable, moderately symptomatic heart failure with an ejection fraction
Revised on April 21, 2006
Accepted on April 28, 2006
Cost-Effectiveness of Defibrillator Therapy or Amiodarone in Chronic Stable Heart Failure. Results From the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)
Daniel B. Mark MD, MPH*,
35%, particularly those in NYHA class II, as long as the benefits of ICD therapy observed in the SCD-HeFT persist for at least 8 years.
Key words: amiodarone • defibrillators, implantable • heart failure, congestive • quality-adjusted life years • cost-benefit analysis
This article has been cited by other articles:
 |
|
 |
|
  M. R. Cowie and on behalf of the co-authors Editorial: The economical challenge in the treatment of chronic heart failure: is primary prophylactic implantable cardioverter defibrillator therapy cost-effective in Europe? Europace, October 1, 2009; 11(10): 1407 - 1408. [Full Text] [PDF]
|
|
|
|
|
|
M. Meine, T. Smith, and R. N.W. Hauer The economical challenge in the treatment of chronic heart failure: is primary prophylactic ICD therapy cost-effective in Europe? Reply Europace, October 1, 2009; 11(10): 1408 - 1410. [Full Text] [PDF]
|
|
|
|
 |
|
 H. Ghanbari, G. Dalloul, R. Hasan, M. Daccarett, S. Saba, S. David, and C. Machado Effectiveness of Implantable Cardioverter-Defibrillators for the Primary Prevention of Sudden Cardiac Death in Women With Advanced Heart Failure: A Meta-analysis of Randomized Controlled Trials Arch Intern Med, September 14, 2009; 169(16): 1500 - 1506. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Tung and C. D. Swerdlow Refining Patient Selection for Primary Prevention Implantable Cardioverter-Defibrillator Therapy: Reeling in a Net Cast Too Widely Circulation, September 8, 2009; 120(10): 825 - 827. [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Myerburg, V. Reddy, and A. Castellanos Indications for implantable cardioverter-defibrillators based on evidence and judgment. J. Am. Coll. Cardiol., August 25, 2009; 54(9): 747 - 763. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Cowie, D. Marshall, M. Drummond, N. Ferko, M. Maschio, M. Ekman, L. de Roy, H. Heidbuchel, Y. Verboven, F. Braunschweig, et al. Lifetime cost-effectiveness of prophylactic implantation of a cardioverter defibrillator in patients with reduced left ventricular systolic function: results of Markov modelling in a European population Europace, June 1, 2009; 11(6): 716 - 726. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Meine, T. Smith, and R. N.W. Hauer The economical challenge in the treatment of chronic heart failure: is primary prophylactic ICD therapy cost-effective in Europe? Europace, June 1, 2009; 11(6): 689 - 691. [Full Text] [PDF]
|
|
|
|
 |
|
 G. Boriani, M. Biffi, C. Martignani, I. Diemberger, C. Valzania, M. Bertini, and A. Branzi Expenditure and value for money: the challenge of implantable cardioverter defibrillators QJM, May 1, 2009; 102(5): 349 - 356. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, K. Michl, et al. 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation J. Am. Coll. Cardiol., April 14, 2009; 53(15): e1 - e90. [Full Text] [PDF]
|
|
|
|
|
|
M. Jessup, W. T. Abraham, D. E. Casey, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. A. Konstam, D. M. Mancini, P. S. Rahko, M. A. Silver, et al. 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation J. Am. Coll. Cardiol., April 14, 2009; 53(15): 1343 - 1382. [Full Text] [PDF]
|
|
|
|
|
|
2009 WRITING GROUP TO REVIEW NEW EVIDENCE AND UPDA, M. Jessup, W. T. Abraham, D. E. Casey, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. A. Konstam, D. M. Mancini, P. S. Rahko, et al. 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation Circulation, April 14, 2009; 119(14): 1977 - 2016. [Full Text] [PDF]
|
|
|
|
|
|
2005 WRITING COMMITTEE MEMBERS, S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, et al. 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation Circulation, April 14, 2009; 119(14): e391 - e479. [Full Text] [PDF]
|
|
|
|
 |
|
 M.R. Cowie Evidence-based medicine within a budget - where should we spend our money? Eur J Heart Fail Suppl, April 1, 2009; 8(suppl_1): i36 - i38. [Full Text] [PDF]
|
|
|
|
 |
|
 D. B. Mark, W. Pan, N. E. Clapp-Channing, K. J. Anstrom, J. R. Ross, R. S. Fox, G. P. Devlin, C. E. Martin, C. Adlbrecht, P. A. Cowper, et al. Quality of Life after Late Invasive Therapy for Occluded Arteries N. Engl. J. Med., February 19, 2009; 360(8): 774 - 783. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. D. Matlock, R. M. Telerant, N. Boyer, D. Kansagara, R. Passman, A. Kadish, S. Sears, and D. B. Mark Defibrillators in Heart Failure and Quality of Life N. Engl. J. Med., January 8, 2009; 360(2): 187 - 189. [Full Text] [PDF]
|
|
|
|
|
|
A. Goette, F. Cantu, L. van Erven, P. Geelen, F. Halimi, J. L. Merino, J. M. Morgan, and on behalf of the Scientific Initiative Committee o Performance and survival of transvenous defibrillation leads: need for a European data registry Europace, January 1, 2009; 11(1): 31 - 34. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Cohen and M. R. Reynolds Interpreting the results of cost-effectiveness studies. J. Am. Coll. Cardiol., December 16, 2008; 52(25): 2119 - 2126. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Swedberg, J. Cleland, M. R. Cowie, M. Nieminen, S. G. Priori, L. Tavazzi, D. J. van Veldhuisen, L. Alonso-Pulpon, J. Camm, K. Dickstein, et al. Successful treatment of heart failure with devices requires collaboration Eur J Heart Fail, December 1, 2008; 10(12): 1229 - 1235. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. W. Stevenson, A. S. Hellkamp, C. V. Leier, G. Sopko, T. Koelling, J. W. Warnica, W. T. Abraham, E. K. Kasper, J. G. Rogers, R. M. Califf, et al. Changing Preferences for Survival After Hospitalization With Advanced Heart Failure J. Am. Coll. Cardiol., November 18, 2008; 52(21): 1702 - 1708. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Gold, J. H. Ip, O. Costantini, J. E. Poole, S. McNulty, D. B. Mark, K. L. Lee, and G. H. Bardy Role of Microvolt T-Wave Alternans in Assessment of Arrhythmia Vulnerability Among Patients With Heart Failure and Systolic Dysfunction: Primary Results From the T-Wave Alternans Sudden Cardiac Death in Heart Failure Trial Substudy Circulation, November 11, 2008; 118(20): 2022 - 2028. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. M. Albert Prediction of Sudden Cardiac Death in Patients With Coronary Heart Disease: The Challenge Ahead Circ Cardiovasc Imaging, November 1, 2008; 1(3): 175 - 177. [Full Text] [PDF]
|
|
|
|
|
|
M. Biffi, M. Ziacchi, M. Bertini, D. Sangiorgi, D. Corsini, C. Martignani, I. Diemberger, and G. Boriani Longevity of implantable cardioverter-defibrillators: implications for clinical practice and health care systems Europace, November 1, 2008; 10(11): 1288 - 1295. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Tung, P. Zimetbaum, and M. E. Josephson A Critical Appraisal of Implantable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death J. Am. Coll. Cardiol., September 30, 2008; 52(14): 1111 - 1121. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. W. Chapa, H.-J. Lee, C.-W. Kao, E. Friedmann, S. A. Thomas, J. Anderson, and G. H. Bardy Reducing Mortality With Device Therapy in Heart Failure Patients Without Ventricular Arrhythmias Am. J. Crit. Care., September 1, 2008; 17(5): 443 - 452. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Ding, W. Hua, H. Niu, K. Chen, and S. Zhang Primary prevention of sudden cardiac death using implantable cardioverter defibrillators Europace, September 1, 2008; 10(9): 1034 - 1041. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. W. Yancy Predicting Life Expectancy in Heart Failure JAMA, June 4, 2008; 299(21): 2566 - 2567. [Full Text] [PDF]
|
|
|
|
|
|
H. M. Sulaiman, C. O'Loughlin, M. Daly, C. Conlon, M. Ledwidge, D. McCaffrey, and K. McDonald Need and evolution of need for device therapy in a community heart failure population Eur J Heart Fail, June 1, 2008; 10(6): 601 - 607. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons J. Am. Coll. Cardiol., May 27, 2008; 51(21): e1 - e62. [Full Text] [PDF]
|
|
|
|
|
|
A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. Mark Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons J. Am. Coll. Cardiol., May 27, 2008; 51(21): 2085 - 2105. [Full Text] [PDF]
|
|
|
|
|
|
Writing Committee Members, A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons Circulation, May 27, 2008; 117(21): 2820 - 2840. [Full Text] [PDF]
|
|
|
|
|
|
Writing Committee Members, A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons Circulation, May 27, 2008; 117(21): e350 - e408. [Full Text] [PDF]
|
|
|
|
|
|
J. B. Johansen, S. S. Pedersen, H. Spindler, K. Andersen, J. C. Nielsen, and P. T. Mortensen Symptomatic heart failure is the most important clinical correlate of impaired quality of life, anxiety, and depression in implantable cardioverter-defibrillator patients: a single-centre, cross-sectional study in 610 patients Europace, May 1, 2008; 10(5): 545 - 551. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. M. Krumholz and F. A. Masoudi The Year in Epidemiology, Health Services Research, and Outcomes Research J. Am. Coll. Cardiol., December 4, 2007; 50(23): 2254 - 2262. [Full Text] [PDF]
|
|
|
|
 |
|
 G. Boriani, R. Ricci, T. Toselli, R. Ferrari, A. Branzi, and M. Santini Implantable cardioverter defibrillators: from evidence of trials to clinical practice Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I66 - I73. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Passman, H. Subacius, B. Ruo, A. Schaechter, A. Howard, S. F. Sears, and A. Kadish Implantable Cardioverter Defibrillators and Quality of Life: Results From the Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation Study Arch Intern Med, November 12, 2007; 167(20): 2226 - 2232. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. F. Hernandez, G. C. Fonarow, L. Liang, S. M. Al-Khatib, L. H. Curtis, K. A. LaBresh, C. W. Yancy, N. M. Albert, and E. D. Peterson Sex and Racial Differences in the Use of Implantable Cardioverter-Defibrillators Among Patients Hospitalized With Heart Failure JAMA, October 3, 2007; 298(13): 1525 - 1532. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Ezekowitz, B. H. Rowe, D. M. Dryden, N. Hooton, B. Vandermeer, C. Spooner, and F. A. McAlister Systematic Review: Implantable Cardioverter Defibrillators for Adults with Left Ventricular Systolic Dysfunction Ann Intern Med, August 21, 2007; 147(4): 251 - 262. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Passman and A. Kadish Sudden Death Prevention With Implantable Devices Circulation, July 31, 2007; 116(5): 561 - 571. [Full Text] [PDF]
|
|
|
|
|
|
W. H. Maisel Transvenous Implantable Cardioverter-Defibrillator Leads: The Weakest Link Circulation, May 15, 2007; 115(19): 2461 - 2463. [Full Text] [PDF]
|
|
|
|
 |
|
 M. L. Weisfeldt and S. J. Zieman Advances In The Prevention And Treatment Of Cardiovascular Disease Health Aff., January 1, 2007; 26(1): 25 - 37. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 ICD Cost-Effectiveness in Heart Failure Journal Watch Cardiology, July 26, 2006; 2006(726): 2 - 2. [Full Text]
|
|
|
|
|
|
L. W. Stevenson Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Death in Heart Failure: Are There Enough Bangs for the Bucks? Circulation, July 11, 2006; 114(2): 101 - 103. [Full Text] [PDF]
|
|