Tags

Type your tag names separated by a space and hit enter

Cost-effectiveness of implantable cardioverter defibrillators in patients >or=65 years of age.
Am Heart J. 2010 Jul; 160(1):122-31.AH

Abstract

BACKGROUND

More than 80% of sudden cardiac deaths (SCDs) occur in patients >or=65 years old; the cost-effectiveness of implantable cardioverter defibrillator (ICD) therapy in older patients remains unclear. We sought to examine the cost-effectiveness of ICD therapy in at-risk patients >or=65 years old.

METHODS

We developed a Markov model to evaluate lifetime costs and benefits of ICD therapy compared with optimal medical therapy in patients >or=65 years of age with left ventricular dysfunction. Data were derived from the literature and existing clinical trials of primary prevention of SCD. Outcome measures included life years, quality-adjusted life years, costs, and incremental cost-effectiveness.

RESULTS

Benefits and costs of ICD therapy in older individuals varied widely by clinical-trial population. In the 5 trials considered, for patients >or=65 years of age, ICDs demonstrated a life expectancy benefit compared with control therapy (incremental cost-effectiveness ratios ranging from $37,031-$138,458 per quality-adjusted life year). For 75-year-old patients, the findings were qualitatively similar, although cost-effectiveness was reduced in all trial populations. In sensitivity analyses, cost-effectiveness of ICD therapy in older individuals depended upon the trial population, quality of life, device cost, and frequency of generator replacement. Sensitivity analyses on other variables did not change the results substantially.

CONCLUSIONS

The cost-effectiveness of ICD therapy for primary prevention in older patients varies widely among trials. Given an aging US population and the high risk of SCD in these individuals, further studies of ICD therapy and their cost-effectiveness-specifically in older patients-are needed.

Authors+Show Affiliations

Duke Clinical Research Institute, Duke University, Durham, NC, USA. gillian.sanders@duke.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

20598982

Citation

Sanders, Gillian D., et al. "Cost-effectiveness of Implantable Cardioverter Defibrillators in Patients >or=65 Years of Age." American Heart Journal, vol. 160, no. 1, 2010, pp. 122-31.
Sanders GD, Kong MH, Al-Khatib SM, et al. Cost-effectiveness of implantable cardioverter defibrillators in patients >or=65 years of age. Am Heart J. 2010;160(1):122-31.
Sanders, G. D., Kong, M. H., Al-Khatib, S. M., & Peterson, E. D. (2010). Cost-effectiveness of implantable cardioverter defibrillators in patients >or=65 years of age. American Heart Journal, 160(1), 122-31. https://doi.org/10.1016/j.ahj.2010.04.021
Sanders GD, et al. Cost-effectiveness of Implantable Cardioverter Defibrillators in Patients >or=65 Years of Age. Am Heart J. 2010;160(1):122-31. PubMed PMID: 20598982.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of implantable cardioverter defibrillators in patients >or=65 years of age. AU - Sanders,Gillian D, AU - Kong,Melissa H, AU - Al-Khatib,Sana M, AU - Peterson,Eric D, PY - 2009/11/12/received PY - 2010/04/24/accepted PY - 2010/7/6/entrez PY - 2010/7/6/pubmed PY - 2010/8/18/medline SP - 122 EP - 31 JF - American heart journal JO - Am Heart J VL - 160 IS - 1 N2 - BACKGROUND: More than 80% of sudden cardiac deaths (SCDs) occur in patients >or=65 years old; the cost-effectiveness of implantable cardioverter defibrillator (ICD) therapy in older patients remains unclear. We sought to examine the cost-effectiveness of ICD therapy in at-risk patients >or=65 years old. METHODS: We developed a Markov model to evaluate lifetime costs and benefits of ICD therapy compared with optimal medical therapy in patients >or=65 years of age with left ventricular dysfunction. Data were derived from the literature and existing clinical trials of primary prevention of SCD. Outcome measures included life years, quality-adjusted life years, costs, and incremental cost-effectiveness. RESULTS: Benefits and costs of ICD therapy in older individuals varied widely by clinical-trial population. In the 5 trials considered, for patients >or=65 years of age, ICDs demonstrated a life expectancy benefit compared with control therapy (incremental cost-effectiveness ratios ranging from $37,031-$138,458 per quality-adjusted life year). For 75-year-old patients, the findings were qualitatively similar, although cost-effectiveness was reduced in all trial populations. In sensitivity analyses, cost-effectiveness of ICD therapy in older individuals depended upon the trial population, quality of life, device cost, and frequency of generator replacement. Sensitivity analyses on other variables did not change the results substantially. CONCLUSIONS: The cost-effectiveness of ICD therapy for primary prevention in older patients varies widely among trials. Given an aging US population and the high risk of SCD in these individuals, further studies of ICD therapy and their cost-effectiveness-specifically in older patients-are needed. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/20598982/Cost_effectiveness_of_implantable_cardioverter_defibrillators_in_patients_>or=65_years_of_age_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(10)00349-2 DB - PRIME DP - Unbound Medicine ER -