Cost effectiveness of the implantable cardioverter defibrillator: a preliminary analysis

BACKGROUND: An implantable cardioverter defibrillator (ICD) may be effective in reducing the risk of sudden cardiac death. The high cost of ICD treatment, however, compared with alternatives raises the question of whether this new technology is an efficient use of scarce health care resources. OBJECTIVE: To estimate the incremental cost effectiveness of the implantable cardioverter defibrillator compared with drug treatment with amiodarone in the management of patients at high risk of sudden cardiac death. DESIGN: A cost effectiveness model was constructed from data already published and other secondary sources. Differences in patient survival were calculated from life tables for comparable ICD and amiodarone patient series. Costs were based on typical patient management protocols derived from current United Kingdom practice and interviews with physicians. MAIN OUTCOME MEASURES: Cost effectiveness of ICD treatment was computed over 20 years; all future costs and effects were discounted at 6% per year. RESULTS: Estimated life expectancy was 11.1 and 6.7 years with ICD and amiodarone respectively; the discounted 20 year difference lies in the range 1.7 to 3.7 years. Discounted 20 year treatment costs were 28,400 pounds for the ICD and 2300 pounds for amiodarone. Cost effectiveness of ICD treatment lies in the range of 15,400 pounds to 8200 pounds per life-year gained. CONCLUSIONS: Cost effectiveness of ICD treatment is similar to some existing cardiac programmes funded under the NHS but uncertainty exists due to limitations of the data. Costs of ICD treatment may fall in the future as the life of the device increases and less invasive implantation methods are needed. The effectivess of ICD compared with amiodarone is currently being studied by a randomised controlled trial.