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The cost effectiveness of implantable cardioverter-defibrillators: results from the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II.
J Am Coll Cardiol. 2006 Jun 06; 47(11):2310-8.JACC

Abstract

OBJECTIVES

We sought to evaluate the cost implications of the implantable cardioverter-defibrillator (ICD), using utilization, cost, and survival data from the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II.

BACKGROUND

This trial showed that prophylactic implantation of a defibrillator reduces the rate of mortality in patients who experienced a previous myocardial infarction and low left ventricular ejection fraction. Given the size of the eligible population, the cost effectiveness of the ICD has substantial implications.

METHODS

Our research comprises the cost-effectiveness component of the randomized controlled trial, MADIT-II, based on utilization, cost, and survival information from 1,095 U.S. patients who were assigned randomly to receive an ICD or conventional medical care. Utilization data were converted to costs using a variety of national and hospital-specific data. The incremental cost-effectiveness ratio (iCER) was calculated as the difference in discounted costs divided by the difference in discounted life expectancy within 3.5 years. Secondary analyses included projections of survival (using three alternative assumptions), corresponding cost assumptions, and the resulting cost-effectiveness ratios until 12 years after randomization.

RESULTS

During the 3.5-year period of the study, the average survival gain for the defibrillator arm was 0.167 years (2 months), the additional costs were 39,200 dollars, and the iCER was 235,000 dollars per year-of-life saved. In three alternative projections to 12 years, this ratio ranged from 78,600 dollars to 114,000 dollars.

CONCLUSIONS

The estimated cost per life-year saved by the ICD in the MADIT-II study is relatively high at 3.5 years but is projected to be substantially lower over the course of longer time horizons.

Authors+Show Affiliations

Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. jzwanzig@uic.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16750701

Citation

Zwanziger, Jack, et al. "The Cost Effectiveness of Implantable Cardioverter-defibrillators: Results From the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II." Journal of the American College of Cardiology, vol. 47, no. 11, 2006, pp. 2310-8.
Zwanziger J, Hall WJ, Dick AW, et al. The cost effectiveness of implantable cardioverter-defibrillators: results from the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II. J Am Coll Cardiol. 2006;47(11):2310-8.
Zwanziger, J., Hall, W. J., Dick, A. W., Zhao, H., Mushlin, A. I., Hahn, R. M., Wang, H., Andrews, M. L., Mooney, C., Wang, H., & Moss, A. J. (2006). The cost effectiveness of implantable cardioverter-defibrillators: results from the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II. Journal of the American College of Cardiology, 47(11), 2310-8.
Zwanziger J, et al. The Cost Effectiveness of Implantable Cardioverter-defibrillators: Results From the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II. J Am Coll Cardiol. 2006 Jun 6;47(11):2310-8. PubMed PMID: 16750701.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The cost effectiveness of implantable cardioverter-defibrillators: results from the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II. AU - Zwanziger,Jack, AU - Hall,W Jackson, AU - Dick,Andrew W, AU - Zhao,Hongwei, AU - Mushlin,Alvin I, AU - Hahn,Rebecca Marron, AU - Wang,Hongkun, AU - Andrews,Mark L, AU - Mooney,Cathleen, AU - Wang,Hongyue, AU - Moss,Arthur J, Y1 - 2006/05/04/ PY - 2005/12/04/received PY - 2006/03/02/revised PY - 2006/03/16/accepted PY - 2006/6/6/pubmed PY - 2006/6/28/medline PY - 2006/6/6/entrez SP - 2310 EP - 8 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 47 IS - 11 N2 - OBJECTIVES: We sought to evaluate the cost implications of the implantable cardioverter-defibrillator (ICD), using utilization, cost, and survival data from the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II. BACKGROUND: This trial showed that prophylactic implantation of a defibrillator reduces the rate of mortality in patients who experienced a previous myocardial infarction and low left ventricular ejection fraction. Given the size of the eligible population, the cost effectiveness of the ICD has substantial implications. METHODS: Our research comprises the cost-effectiveness component of the randomized controlled trial, MADIT-II, based on utilization, cost, and survival information from 1,095 U.S. patients who were assigned randomly to receive an ICD or conventional medical care. Utilization data were converted to costs using a variety of national and hospital-specific data. The incremental cost-effectiveness ratio (iCER) was calculated as the difference in discounted costs divided by the difference in discounted life expectancy within 3.5 years. Secondary analyses included projections of survival (using three alternative assumptions), corresponding cost assumptions, and the resulting cost-effectiveness ratios until 12 years after randomization. RESULTS: During the 3.5-year period of the study, the average survival gain for the defibrillator arm was 0.167 years (2 months), the additional costs were 39,200 dollars, and the iCER was 235,000 dollars per year-of-life saved. In three alternative projections to 12 years, this ratio ranged from 78,600 dollars to 114,000 dollars. CONCLUSIONS: The estimated cost per life-year saved by the ICD in the MADIT-II study is relatively high at 3.5 years but is projected to be substantially lower over the course of longer time horizons. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/16750701/The_cost_effectiveness_of_implantable_cardioverter_defibrillators:_results_from_the_Multicenter_Automatic_Defibrillator_Implantation_Trial__MADIT__II_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(06)00967-3 DB - PRIME DP - Unbound Medicine ER -