Key result
Implantation of a cardioverter defibrillator was nearly twelve times more expensive than amiodarone for preventing sudden cardiac death, costing 621,833.18 RSD per QALY gained compared to 52,644.25 RSD per QALY for amiodarone.
Why the study?
Does an implantable cardioverter defibrillator improve cost-effectiveness compared to amiodarone in preventing sudden cardiac death?
Does an implantable cardioverter defibrillator improve cost-effectiveness compared to amiodarone in preventing sudden cardiac death?
In a 5-year Markov model based on Serbian healthcare costs, amiodarone was found to be a more cost-effective strategy than ICD implantation for preventing sudden cardiac death.
Amiodarone may be preferred in resource-limited settings; leaves open need for local prospective validation before broader adoption.
Sudden cardiac death is natural death caused by previous heart disease, when within an hour from the onset of symptoms ensue loss of consciousness and cessation of circulation. Many studies have confirmed that malignant ventricular arrhythmias are the most common cause of sudden cardiac death. Alternatives for prevention of sudden cardiac death are antiarrhythmic drug treatment, primarily amiodarone, and implantation of cardioverter defibrillator. The aim of this pharmacoeconomic study was to compare the cost-effectiveness of implantable cardioverter defibrillator and amiodarone in preventing sudden cardiac death. The Markov model was designed based on data from the literature, and analyzed using the software TreeAge®. The time horizon was five years. The duration of one cycle was one month. Effect for each model state was expressed in quality-adjusted life years gained (QALYs). The Monte Carlo simulation was used for 1.000 hypothetical patients. Implantation of cardioverter defibrillator proved to be pharmacoeconomically inferior method of preventing sudden cardiac death, nearly twelve times more expensive than applying amiodarone, i.e. 621.833,18 dinars per QALY gained in comparison to 52.644,25 dinars per QALY gained for amiodarone. The study showed that the method with superior cost/effectiveness ratio was preventing sudden cardiac death by amiodarone. It is expected that further research will indicate a subpopulation in which the implantable cardioverter defibrillator will show better cost/effectiveness ratio than amiodarone.
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Marina Ž. Mijajlović (2012) studied Prevention of sudden cardiac death (n=1,000). Implantable cardioverter defibrillator (ICD) vs. Amiodarone was evaluated on Cost per quality-adjusted life year (QALY) gained in RSD (ICER -1858524.043). Implantation of a cardioverter defibrillator was nearly twelve times more expensive than amiodarone for preventing sudden cardiac death, costing 621,833.18 RSD per QALY gained compared to 52,644.25 RSD per QALY for amiodarone.
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