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Implantable or External Defibrillators for Individuals at Increased Risk of Cardiac Arrest: Where Cost-Effectiveness Hits Fiscal Reality
dc.contributor.authorCram, Peteren_US
dc.contributor.authorKatz, Daviden_US
dc.contributor.authorVijan, Sandeepen_US
dc.contributor.authorKent, David M.en_US
dc.contributor.authorLanga, Kenneth M.en_US
dc.contributor.authorFendrick, A. Marken_US
dc.date.accessioned2010-06-01T21:44:51Z
dc.date.available2010-06-01T21:44:51Z
dc.date.issued2006-09en_US
dc.identifier.citationCram, Peter; Katz, David; Vijan, Sandeep; Kent, David M.; Langa, Kenneth M.; Fendrick, A. Mark (2006). "Implantable or External Defibrillators for Individuals at Increased Risk of Cardiac Arrest: Where Cost-Effectiveness Hits Fiscal Reality." Value in Health 9(5): 292-302. <http://hdl.handle.net/2027.42/74790>en_US
dc.identifier.issn1098-3015en_US
dc.identifier.issn1524-4733en_US
dc.identifier.urihttps://hdl.handle.net/2027.42/74790
dc.identifier.urihttp://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=16961547&dopt=citationen_US
dc.description.abstractObjcetives:  Implantable cardioverter defibrillators (ICDs) are highly effective at preventing cardiac arrest, but their availability is limited by high cost. Automated external defibrillators (AEDs) are likely to be less effective, but also less expensive. We used decision analysis to evaluate the clinical and economic trade-offs of AEDs, ICDs, and emergency medical services equipped with defibrillators (EMS-D) for reducing cardiac arrest mortality. Methods:  A Markov model was developed to compare the cost-effectiveness of three strategies in adults meeting entry criteria for the MADIT II Trial: strategy 1, individuals experiencing cardiac arrest are treated by EMS-D; strategy 2, individuals experiencing cardiac arrest are treated with an in-home AED; and strategy 3, individuals receive a prophylactic ICD. The model was then used to quantify the aggregate societal benefit of these three strategies under the conditions of a constrained federal budget. Results:  Compared with EMS-D, in-home AEDs produced a gain of 0.05 quality-adjusted life-years (QALYs) at an incremental cost of $5225 ($104,500 per QALY), while ICDs produced a gain of 0.90 QALYs at a cost of $114,660 ($127,400 per QALY). For every $1 million spent on defibrillators, 1.7 additional QALYs are produced by purchasing AEDs (9.6 QALYs/$million) instead of ICDs (7.9 QALYs/$million). Results were most sensitive to defibrillator complication rates and effectiveness, defibrillator cost, and adults’ risk of cardiac arrest. Conclusions:  Both AEDs and ICDs reduce cardiac arrest mortality, but AEDs are significantly less expensive and less effective. If financial constraints were to lead to rationing of defibrillators, it might be preferable to provide more people with a less effective and less expensive intervention (in-home AEDs) instead of providing fewer people with a more effective and more costly intervention (ICDs).en_US
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dc.format.extent3109 bytes
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dc.publisherBlackwell Publishing Incen_US
dc.rights2006, International Society for Pharmacoeconomics and Outcomes Research (ISPOR)en_US
dc.subject.otherCost-effectivenessen_US
dc.subject.otherDefibrillatorsen_US
dc.subject.otherEmergency Medical Servicesen_US
dc.subject.otherHeart Arresten_US
dc.subject.otherRationingen_US
dc.titleImplantable or External Defibrillators for Individuals at Increased Risk of Cardiac Arrest: Where Cost-Effectiveness Hits Fiscal Realityen_US
dc.typeArticleen_US
dc.subject.hlbsecondlevelMedicine (General)en_US
dc.subject.hlbtoplevelHealth Sciencesen_US
dc.description.peerreviewedPeer Revieweden_US
dc.contributor.affiliationumUniversity of Michigan School of Medicine, Ann Arbor, MI, USA;en_US
dc.contributor.affiliationumUniversity of Michigan School of Public Health, Ann Arbor, MI, USAen_US
dc.contributor.affiliationotherUniversity of Iowa College of Medicine, Iowa City, IA, USA;en_US
dc.contributor.affiliationotherUniversity of Iowa College of Public Health, Iowa City, IA, USA;en_US
dc.contributor.affiliationotherAnn Arbor Veterans Affairs Health Services Research and Development Field Program, Ann Arbor, MI, USA;en_US
dc.contributor.affiliationotherInstitute for Clinical Research and Health Policy Studies, Tufts–New England Medical Center, Boston, MA, USA;en_US
dc.identifier.pmid16961547en_US
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/74790/1/j.1524-4733.2006.00118.x.pdf
dc.identifier.doi10.1111/j.1524-4733.2006.00118.xen_US
dc.identifier.sourceValue in Healthen_US
dc.identifier.citedreferenceBerenson A. A cancer drug shows promise at a price that many can’t pay. The New York Times, February 15, 2006: A1.en_US
dc.identifier.citedreferenceGinsburg PB. Controlling health care costs. N Engl J Med 2004; 351: 1591 – 3.en_US
dc.identifier.citedreferenceHalvorson GC. Commentary—Current MSA theory: well-meaning but futile. Health Serv Res 2004; 39 ( Pt 2 ): 1119 – 22.en_US
dc.identifier.citedreferenceRobinson JC. Health savings accounts—the ownership society in health care. N Engl J Med 2005; 353: 1199 – 202.en_US
dc.identifier.citedreferenceGillick MR. Medicare coverage for technological innovations—time for new criteria? N Engl J Med 2004; 350: 2199 – 203.en_US
dc.identifier.citedreferenceHeffler S, Smith S, Keehan S, et al. Health spending projections through 2013. Health Aff 2004 ;( Suppl. Web Exclusives ): W4 – 79–93.en_US
dc.identifier.citedreferenceCalmes J. Elephant in the room: budget wish lists come and go but “entitlements” outweigh all. The Wall Street Journal February 3, 2006: 1.en_US
dc.identifier.citedreferenceMoss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med 1996; 335: 1933 – 40.en_US
dc.identifier.citedreferenceBuxton AE, Lee KL, Fisher JD, et al. A randomized study of the prevention of sudden death in patients with coronary artery disease. N Engl J Med 1999; 341: 1882 – 90.en_US
dc.identifier.citedreferenceGold MR, Siegel JE, Russell LB, Weinstein MC, eds. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press, 1996.en_US
dc.identifier.citedreferenceMoss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002; 346: 877 – 83.en_US
dc.identifier.citedreferenceBardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005; 352: 225 – 37.en_US
dc.identifier.citedreferenceAl-Khatib SM, Anstrom KJ, Eisenstein EL, et al. Clinical and economic implications of the multicenter automatic defibrillator implantation trial-II. Ann Intern Med 2005; 142: 593 – 600.en_US
dc.identifier.citedreferenceSanders GD, Hlatky MA, Owens DK. Cost-effectiveness of implantable cardioverter-defibrillators. N Engl J Med 2005; 353: 1471 – 80.en_US
dc.identifier.citedreferenceMcClellan MB, Tunis SR. Medicare coverage of ICDs. N Engl J Med 2005; 352: 222 – 4.en_US
dc.identifier.citedreferenceValenzuela TD, Roe DJ, Nichol G, et al. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med 2000; 343: 1206 – 9.en_US
dc.identifier.citedreferenceCaffrey SL, Willoughby PJ, Pepe PE, Becker LB. Public use of automated external defibrillators. N Engl J Med 2002; 347: 1242 – 7.en_US
dc.identifier.citedreferenceCram P, Vijan S, Katz D, Fendrick AM. Cost-effectiveness of in-home automated external defibrillators for individuals at increased risk of sudden cardiac death. J Gen Intern Med 2005; 20: 251 – 8.en_US
dc.identifier.citedreference19  Healthcare inflation index. http://www.cms.hhs.gov/statistics/health-indicators/t9.asp. [Accessed March 11, 2004.]en_US
dc.identifier.citedreferenceGreenberg H, Case RB, Moss AJ, et al. Analysis of mortality events in the multicenter automatic defibrillator implantation trial (MADIT-II)*1. J Am Coll Cardiol 2004; 43: 1459 – 65.en_US
dc.identifier.citedreferenceHohnloser SH, Kuck KH, Dorian P, et al. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med 2004; 351: 2481 – 8.en_US
dc.identifier.citedreference22  National Center for Health Statistics. United States Life Tables, 2001. 2001.en_US
dc.identifier.citedreferenceStiell IG, Wells GA, Field BJ, et al. Improved out-of-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program: OPALS study phase II. Ontario Prehospital Advanced Life Support. JAMA 1999; 281: 1175 – 81.en_US
dc.identifier.citedreferenceCobb LA, Fahrenbruch CE, Walsh TR, et al. Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation. JAMA 1999; 281: 1182 – 8.en_US
dc.identifier.citedreferenceLadwig KH, Schoefinius A, Danner R, et al. Effects of early defibrillation by ambulance personnel on short- and long-term outcome of cardiac arrest survival: the Munich experiment. Chest 1997; 112: 1584 – 91.en_US
dc.identifier.citedreferenceEisenberg MS, Horwood BT, Cummins RO, et al. Cardiac arrest and resus citation: a tale of 29 cities. Ann Emerg Med 1990; 19: 179 – 86.en_US
dc.identifier.citedreferenceBecker LB, Ostrander MP, Barrett J, Kondos GT. Outcome of CPR in a large metropolitan area—where are the survivors? Ann Emerg Med 1991; 20: 355 – 61.en_US
dc.identifier.citedreferenceStults KR, Brown DD, Schug VL, Bean JA. Prehospital defibrillation performed by emergency medical technicians in rural communities. N Engl J Med 1984; 310: 219 – 23.en_US
dc.identifier.citedreferenceLombardi G, Gallagher J, Gennis P. Outcome of out-of-hospital cardiac arrest in New York City. The Pre-Hospital Arrest Survival Evaluation (PHASE) Study. JAMA 1994; 271: 678 – 83.en_US
dc.identifier.citedreferenceValenzuela TD, Roe DJ, Cretin S, et al. Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model. Circulation 1997; 96: 3308 – 13.en_US
dc.identifier.citedreferenceLarsen MP, Eisenberg MS, Cummins RO, Hallstrom AP. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med 1993; 22: 1652 – 8.en_US
dc.identifier.citedreferenceValenzuela TD, Spaite DW, Meislin HW, et al. Emergency vehicle intervals versus collapse-to-CPR and collapse-to-defibrillation intervals: monitoring emergency medical services system performance in sudden cardiac arrest. Ann Emerg Med 1993; 22: 1678 – 83.en_US
dc.identifier.citedreferenceEisenberg MS. Is it time for over-the-counter defibrillators? JAMA 2000; 284: 1435 – 8.en_US
dc.identifier.citedreferenceOrnato JP, McNeill SE, Craren EJ, Nelson NM. Limitation on effectiveness of rapid defibrillation by emergency medical technicians in a rural setting. Ann Emerg Med 1984; 13: 1096 – 9.en_US
dc.identifier.citedreferenceEisenberg MS, Mengert TJ. Cardiac resuscitation. N Engl J Med 2001; 344: 1304 – 13.en_US
dc.identifier.citedreferenceWeaver WD, Peberdy MA. Defibrillators in public places—one step closer to home. N Engl J Med 2002; 347: 1223 – 4.en_US
dc.identifier.citedreferenceHolmberg M, Holmberg S, Herlitz J. The problem of out-of-hospital cardiac-arrest prevalence of sudden death in Europe today. Am J Cardiol 1999; 83: 88D – 90D.en_US
dc.identifier.citedreference38  The Public Access Defibrillation Trial Investigators. Public-access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med 2004; 351: 637 – 46.en_US
dc.identifier.citedreferenceBunch TJ, White RD, Gersh BJ, et al. Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 2003; 348: 2626 – 33.en_US
dc.identifier.citedreference40  The Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002; 346: 549 – 56.en_US
dc.identifier.citedreferencede Vos R, de Haes HCJM, Koster RW, de Haan RJ. Quality of survival after cardiopulmonary resuscitation. Arch Intern Med 1999; 159: 249 – 54.en_US
dc.identifier.citedreferenceGranja C, Cabral G, Pinto AT, Costa-Pereira A. Quality of life 6-months after cardiac arrest. Resuscitation 2002; 55: 37 – 44.en_US
dc.identifier.citedreferenceSedgwick ML, Watson J, Dalziel K, et al. Efficacy of out of hospital defibrillation by ambulance technicians using automated external defibrillators. The Heartstart Scotland Project. Resuscitation 1992; 24: 73 – 87.en_US
dc.identifier.citedreferenceConnolly SJ, Hallstrom AP, Cappato R, et al. Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials. Eur Heart J 2000; 21: 2071 – 8.en_US
dc.identifier.citedreferenceEzekowitz JA, Armstrong PW, McAlister FA. Implantable cardioverter defibrillators in primary and secondary prevention: a systematic review of randomized, controlled trials. Ann Intern Med 2003; 138: 445 – 52.en_US
dc.identifier.citedreferenceHardie K, Hankey GJ, Jamrozik K, et al. Ten-year survival after first-ever stroke in the perth community stroke study. Stroke 2003; 34: 1842 – 6.en_US
dc.identifier.citedreferenceRosenqvist M, Beyer T, Block M, et al. Adverse events with transvenous implantable cardioverter-defibrillators: a prospective multicenter study. Circulation 1998; 98: 663 – 70.en_US
dc.identifier.citedreferenceKadish A, Dyer A, Daubert JP, et al. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med 2004; 350: 2151 – 8.en_US
dc.identifier.citedreferenceMushlin AI, Hall WJ, Zwanziger J, et al. The cost-effectiveness of automatic implantable cardiac defibrillators: results from MADIT. Circulation 1998; 97: 2129 – 35.en_US
dc.identifier.citedreferenceReiffel JA, Dizon J. Cardiology patient page. The implantable cardioverter-defibrillator: patient perspective. Circulation 2002; 105: 1022 – 4.en_US
dc.identifier.citedreferenceChen L, Hay JW. Cost-effectiveness of primary implanted cardioverter defibrillator for sudden death prevention in congestive heart failure. Cardiovasc Drugs Ther 2004; 18: 161 – 70.en_US
dc.identifier.citedreferenceFerguson TB Jr, Ferguson CL, Crites K, Crimmins-Reda P. The additional hospital costs generated in the management of complications of pacemaker and defibrillator implantations. J Thorac Cardiovasc Surg 1996; 111: 742 – 51; discussion 751–2.en_US
dc.identifier.citedreference53  Amiodarone Trials Meta-Analysis Investigators. Effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure: meta-analysis of individual data from 6500 patients in randomised trials. Lancet 1997; 350: 1417 – 24.en_US
dc.identifier.citedreferenceSim I, McDonald KM, Lavori PW, et al. Quantitative overview of randomized trials of amiodarone to prevent sudden cardiac death. Circulation 1997; 96: 2823 – 9.en_US
dc.identifier.citedreferenceStroupe KT, Teal EY, Weiner M, et al. Health care and medication costs and use among older adults with heart failure. Am J Med 2004; 116: 443 – 50.en_US
dc.identifier.citedreferenceSanders GD, Hlatky MA, Every NR, et al. Potential cost-effectiveness of prophylactic use of the implantable cardioverter defibrillator or amiodarone after myocardial infarction. Ann Intern Med 2001; 135: 870 – 83.en_US
dc.identifier.citedreferenceOwens DK, Sanders GD, Harris RA, et al. Cost-effectiveness of implantable cardioverter defibrillators relative to amiodarone for prevention of sudden cardiac death. Ann Intern Med 1997; 126: 1 – 12.en_US
dc.identifier.citedreferenceKuppermann M, Luce BR, McGovern B, et al. An analysis of the cost effectiveness of the implantable defibrillator. Circulation 1990; 81: 91 – 100.en_US
dc.identifier.citedreferenceLarsen G, Hallstrom A, McAnulty J, et al. Cost-effectiveness of the implantable cardioverter-defibrillator versus antiarrhythmic drugs in survivors of serious ventricular tachyarrhythmias: results of the antiarrhythmics versus implantable defibrillators (AVID) economic analysis substudy. Circulation 2002; 105: 2049 – 57.en_US
dc.identifier.citedreferenceWeiss JP, Saynina O, McDonald KM, et al. Effectiveness and cost-effectiveness of implantable cardioverter defibrillators in the treatment of ventricular arrhythmias among medicare beneficiaries. Am J Med 2002; 112: 519 – 27.en_US
dc.identifier.citedreferenceGroeneveld PW, Kwong JL, Liu Y, et al. Cost-effectiveness of automated external defibrillators on airlines. JAMA 2001; 286: 1482 – 9.en_US
dc.identifier.citedreferenceNichol G, Hallstrom AP, Ornato JP, et al. Potential cost-effectiveness of public access defibrillation in the United States. Circulation 1998; 97: 1315 – 20.en_US
dc.identifier.citedreferenceTaylor TN, Davis PH, Torner JC, et al. Lifetime cost of stroke in the United States. Stroke 1996; 27: 1459 – 66.en_US
dc.identifier.citedreferenceTsevat J, Goldman L, Soukup JR, et al. Stability of time-tradeoff utilities in survivors of myocardial infarction. Med Decis Making 1993; 13: 161 – 5.en_US
dc.identifier.citedreferenceFryback DG, Dasbach EJ, Klein R, et al. The Beaver Dam Health Outcomes Study: initial catalog of health-state quality factors. Med Decis Making 1993; 13: 89 – 102.en_US
dc.identifier.citedreferenceVlay SC. The automatic internal cardioverter-defibrillator: comprehensive clinical follow-up, economic and social impact—the Stony Brook experience. Am Heart J 1986; 112: 189 – 94.en_US
dc.identifier.citedreferencePycha C, Gulledge AD, Hutzler J, et al. Psychological responses to the implantable defibrillator: preliminary observations. Psychosomatics 1986; 27: 841 – 5.en_US
dc.identifier.citedreferenceNichol G, Stiell IG, Hebert P, et al. What is the quality of life for survivors of cardiac arrest? A prospective study. Acad Emerg Med 1999; 6: 95 – 102.en_US
dc.identifier.citedreferenceGage BF, Cardinalli AB, Owens DK. The effect of stroke and stroke prophylaxis with aspirin or warfarin on quality of life. Arch Intern Med 1996; 156: 1829 – 36.en_US
dc.identifier.citedreferenceSamsa GP, Matchar DB, Williams GR, Levy DE. Cost-effectiveness of ancrod treatment of acute ischaemic stroke: results from the Stroke Treatment with Ancrod Trial (STAT). J Eval Clin Prac 2002; 8: 61 – 70.en_US
dc.identifier.citedreferenceDoubilet P, Begg CB, Weinstein MC, et al. Probabilistic sensitivity analysis using Monte Carlo simulation. Med Decis Making 1985; 5: 157 – 77.en_US
dc.identifier.citedreferencePasta DJ, Taylor JL, Henning JM. Probabilistic sensitivity analysis incorporating the bootstrap. an example comparing treatments for the eradication of Helicobacter pylori. Med Decis Making 1999; 19: 353 – 63.en_US
dc.identifier.citedreferenceKent DM, Fendrick AM, Langa KM. New and dis-improved. on the evaluation and use of less effective, less expensive medical interventions. Med Decis Making 2004; 24: 281 – 6.en_US
dc.identifier.citedreferenceNeumann PJ. Why don’t Americans use cost-effectiveness analysis? Am J Manag Care 2004; 10: 308 – 12.en_US
dc.identifier.citedreferenceColeman B, McChesney S, Twaddle B. Does the priority scoring system for joint replacement really identify those in most need? N Z Med J 2005; 118: U1463.en_US
dc.identifier.citedreferenceCarlsen B, Norheim OF. “Saying no is no easy matter” a qualitative study of competing concerns in rationing decisions in general practice. BMC Health Serv Res 2005; 5: 70.en_US
dc.identifier.citedreferenceTunis SR. Why medicare has not established criteria for coverage decisions. N Engl J Med 2004; 350: 2196 – 8.en_US
dc.identifier.citedreferenceLindholm LH, Dahlof B, Edelman JM, et al. Effect of losartan on sudden cardiac death in people with diabetes: data from the LIFE study. Lancet 2003; 362: 619 – 20.en_US
dc.identifier.citedreferenceFendrick AM, Smith DG, Chernew ME, Shah SN. A benefit-based copay for prescription drugs: patient contribution based on total benefits, not drug acquisition cost. [see comment]. Am J Manag Care 2001; 7: 861 – 7.en_US
dc.identifier.citedreferenceJorgenson DB, Skarr T, Russell JK, et al. AED use in businesses, public facilities and homes by minimally trained first responders. Resuscitation 2003; 59: 225 – 33.en_US
dc.identifier.citedreferencePereira J. For the fearful: portable defibrillator. The Wall Street Journal September 1, 1999: 1.en_US
dc.identifier.citedreferenceCram P, Vijan S, Wolbrink A, Fendrick AM. The impact of including passive benefits in cost-effectiveness analysis: the case of automated external defibrillators on commercial aircraft. Value Health 2003; 6: 466 – 73.en_US
dc.identifier.citedreferenceGoldman L. Cost-effectiveness in a flat world—can ICDs help the United States get rhythm? N Engl J Med 2005; 353: 1513 – 15.en_US
dc.identifier.citedreferenceBurton TM. A hard choice for heart patients. The Wall Street Journal October 12, 2005: D1.en_US
dc.identifier.citedreferenceMeier B. F.D.A. had report of short circuit in heart devices. The New York Times October 20, 2005: A4.en_US
dc.identifier.citedreferenceHuikuri HV, Tapanainen JM, Lindgren K, et al. Prediction of sudden cardiac death after myocardial infarction in the beta-blocking era. [see comment]. J Am Coll Cardiol 2003; 42: 652 – 8.en_US
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