Cost-effectiveness of continuous real-time intracardiac recurrent event detection and alerting in high-risk acute coronary syndrome patients

Figures

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  Figure 1.. Decision model. the square on the left represents choice between alternative treatments: guardian implantation or standard of care (SOC). Circles represent chance nodes. After guardian implantation, patients remain at-risk for operative mortality and infection requiring explanation. Each month, patients may experience recurrent myocardial infarction (MI), develop heart failure, or other all-cause mortality. Patients having recurrent MI may die, survive with heart failure, or recover. We modeled false positive emergency department (ED) visits, with related costs and disutility. Patients were followed for remaining lifetime, incorporating the cost and benefits for expected rate of implantable cardioverter defibrillator (ICD) implant, with concurrent guardian explant. ED = emergency room, ICD = implantable cardioverter defibrillator, MI = myocardial infarction, SOC = standard of care.

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  Figure 2.. Tornado diagram of incremental cost-effectiveness ratio of Guardian compared to standard of care ($/QALY). one-way sensitivity analyses comparing Guardian strategy to standard of care (SOC). Variables which altered the incremental cost-effectiveness ratio (ICER) by at least $15,000 are included. Vertical line is ICER base-case condition. For each variable, the “X” indicates the ICER under the low value, the circle indicates the ICER at the high value of the variable. ER = emergency room, HF = heart failure, MI = myocardial infarction, SOC = standard of care, QALY = quality-adjusted life year.

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  Figure 3a.. Sensitivity analyses: cost versus frequency of Guardian replacement. X-axis is replacing cost of Guardian ($) and y-axis is Guardian replacement frequency (years). The gray area represents combinations of these two estimates with Guardian strategy costs <$100,000/quality-adjusted life year (QALY) gained, while the black area represents combinations with costs >$100,000/QALY gained as compared to standard of care (SOC). The star represents the base-case assumptions of 6-year replacement frequency and replacement cost of $14,470. SOC = standard of care, QALY = quality-adjusted life year.

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  Figure 3b.. Sensitivity analyses: baseline utility and modifier in utility with guardian. X-axis is the baseline utility for the cohort and y-axis is the modified quality of life (QOL) for guardian strategy patients. The gray area represents combinations of these two estimates with guardian strategy costs <$100,000/quality-adjusted life year (QALY) gained, while black area represents combinations with guardian costs >$100,000/QALY gained as compared to standard of care (SOC). The star represents the base-case assumptions of 0.812 utility at baseline and an incremental utility of 0.02 with guardian. SOC = standard of care, QALY = quality-adjusted life year, qol = quality of life.