Cost-Effectiveness of the Implantable Cardioverter-Defibrillator

BACKGROUND: In the Canadian Implantable Defibrillator Study (CIDS), we assessed the cost-effectiveness of the implantable cardioverter-defibrillator (ICD) in reducing the risk of death in survivors of previous ventricular tachycardia (VT) or fibrillation (VF). METHODS AND RESULTS: Healthcare resource use was collected prospectively on the first 430 patients enrolled in CIDS (n=212 ICD, n=218 amiodarone). Mean cost per patient, adjusted for censoring, was computed for each group based on initial therapy assignment. Incremental cost-effectiveness of ICD therapy was computed as the ratio of the difference in cost (ICD minus amiodarone) to the difference in life expectancy (both discounted at 3% per year). All costs are in 1999 Canadian dollars (C1 approximately US0. 65). Over 6. 3 years, mean cost per patient in the ICD group was C87 715 versus C38 600 in the amiodarone group (difference C49 115; 95% CI C25 502 to C69 508). Life expectancy for the ICD group was 4. 58 years versus 4. 35 years for amiodarone (difference 0. 23, 95% CI -0. 09 to 0. 55), for incremental cost-effectiveness of ICD therapy of C213 543 per life-year gained. ICD benefit was greater in patients with low left ventricular ejection fraction (<35%), and cost-effectiveness in this group was more attractive (C108 484). Alternative extrapolations of survival benefit and costs to 12 years indicated cost-effectiveness in the range of C100 000 to C150 000 per life-year gained. CONCLUSIONS: At C213 543, the value for the money offered by ICD therapy is not attractive by currently accepted standards. Further research is warranted to identify the indications and patient subgroups for whom ICDs are a cost-effective use of resources.