Cost-Effectiveness of Implantable Cardioverter-Defibrillators in Children With Dilated Cardiomyopathy

• Published in: Journal of cardiac failure 2010-09, Vol.16 (9), p.734-741
• Main Authors: Feingold, Brian, MD, MS, Arora, Gaurav, MD, Webber, Steven A., MBChB, Smith, Kenneth J., MD, MS
• Format: Article
• Language: English
• Subjects: Adolescent; Age Factors; Cardiomyopathy, Dilated - economics; Cardiomyopathy, Dilated - therapy; Cardiovascular; Child; Child Welfare - economics; Child Welfare - statistics & numerical data; Cost-Benefit Analysis; cost-effectiveness; Death, Sudden, Cardiac; Decision Support Techniques; Defibrillators, Implantable - economics; Health Care Costs; heart failure; Humans; Markov Chains; Models, Economic; Pediatrics; Quality of Life; Quality-Adjusted Life Years; Stroke Volume; United States; Ventricular Function, Left
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2010.04.009

Abstract Background Implantable cardioverter-defibrillators (ICDs) improve survival and are cost-effective in adults with poor left ventricular function. Because of differences in heart failure etiology, sudden death rates, and ICD complication rates, these findings may not be applicable to children. Methods and Results We developed a Markov model to compare typical management of childhood dilated cardiomyopathy with symptomatic heart failure to prophylactic ICD implantation plus typical management. Model costs included costs of outpatient care, medications, complications, and transplantation. Time horizon was up to 20 years from model entry. Total costs were $433,000 (ICD strategy) and $355,000 (typical management). Although quality adjusted survival was greater in the ICD group (6.78 versus 6.43 quality adjusted life-years [QALY]), the incremental cost-utility ratio was $281,622/QALY saved with the ICD strategy. In sensitivity analyses, the ICD strategy cost less than the $100,000/QALY benchmark for cost-effectiveness only when the annual probability of sudden death exceeded 13% or when strong, sustained benefits in quality of life from the ICD were assumed. Conclusions Prophylactic ICD use in children with dilated cardiomyopathy, poor ventricular function, and symptomatic heart failure does not appear to be cost-effective. This is likely due to lower sudden death rates in this population.