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Titre du document / Document title

Cost-effectiveness of the Implantable cardioverter-defibrillator : Results from the Canadian Implantable Defibrillator Study (CIDS)

Auteur(s) / Author(s)

CIDS Investigators
O'BRIEN Bernie J. (1 2) ; CONNOLLY Stuart J. (3) ; GOEREE Ron (1 2) ; BLACKHOUSE Gordon (1 2) ; WILLAN Andrew (1 2) ; YEE Raymond (4) ; ROBERTS Robin S. (1 5) ; GENT Michael (1 5) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, CANADA
(2) Centre for Evaluation of Medicines, St. Joseph's Hospital, Hamilton, Ontario, CANADA
(3) Department of Medicine, McMaster University, Hamilton, Ontario, CANADA
(4) Department of Medicine, University of Western Ontario, Hamilton, Ontario, CANADA
(5) Hamilton Civic Hospitals Research Centre, Hamilton, Ontario, CANADA

Résumé / Abstract

Background-In the Canadian Implantable Defibrillator Study (CIDS), we assessed the cost-effectiveness of the implantable cardioverter-defibrillator (ICD) in reducing the risk of death in survivors of previous ventricular tachycardia (VT) or fibrillation (VF). Methods and Results-Healthcare resource use was collected prospectively on the first 430 patients enrolled in CIDS (n=212 ICD, n=218 amiodarone). Mean cost per patient, adjusted for censoring, was computed for each group based on initial therapy assignment. Incremental cost-effectiveness of ICD therapy was computed as the ratio of the difference in cost (ICD minus amiodarone) to the difference in life expectancy (both discounted at 3% per year). All costs are in 1999 Canadian dollars (C$1 US$0.65). Over 6.3 years, mean cost per patient in the ICD group was C$87 715 versus C$38 600 in the amiodarone group (difference C$49 115; 95% CI C$25 502 to C$69 508). Life expectancy for the ICD group was 4.58 years versus 4.35 years for amiodarone (difference 0.23, 95% CI -0.09 to 0.55), for incremental cost-effectiveness of ICD therapy of C$213 543 per life-year gained. ICD benefit was greater in patients with low left ventricular ejection fraction (<35%), and cost-effectiveness in this group was more attractive (C$108 484). Alternative extrapolations of survival benefit and costs to 12 years indicated cost-effectiveness in the range of C$100 000 to C$150 000 per life-year gained. Conclusions-At C$213 543, the value for the money offered by ICD therapy is not attractive by currently accepted standards. Further research is warranted to identify the indications and patient subgroups for whom ICDs are a cost-effective use of resources.

Revue / Journal Title

Circulation    ISSN  0009-7322   CODEN CIRCAZ 

Source / Source

2001, vol. 103, no10, pp. 1416-1421 (24 ref.)

Langue / Language

Anglais

Editeur / Publisher

Lippincott Williams & Wilkins, Hagerstown, MD, ETATS-UNIS  (1950) (Revue)

Mots-clés anglais / English Keywords

Defibrillation

;

Defibrillator

;

Implanted

;

Human

;

Costs

;

Health economy

;

Exploration

;

Canada

;

Ventricular tachycardia

;

Treatment

;

Treatment efficiency

;

Chemotherapy

;

Amiodarone

;

Comparative study

;

Iodine Organic compounds

;

North America

;

America

;

Intensive cardiocirculatory care

;

Instrumentation therapy

;

Public health

;

Cardiovascular disease

;

Heart disease

;

Arrhythmia

;

Excitability disorder

;

Antiarrhythmic agent

;

Mots-clés français / French Keywords

Défibrillation

;

Défibrillateur

;

Implanté

;

Homme

;

Coût

;

Economie santé

;

Exploration

;

Canada

;

Tachycardie ventriculaire

;

Traitement

;

Efficacité traitement

;

Chimiothérapie

;

Amiodarone

;

Etude comparative

;

Iode Composé organique

;

Amérique du Nord

;

Amérique

;

Réanimation cardiocirculatoire

;

Traitement instrumental

;

Santé publique

;

Appareil circulatoire pathologie

;

Cardiopathie

;

Trouble rythme cardiaque

;

Trouble excitabilité

;

Antiarythmique

;

Mots-clés espagnols / Spanish Keywords

Desfibrilación

;

Desfibrilador

;

Implantado

;

Hombre

;

Costo

;

Economía salud

;

Exploración

;

Canada

;

Taquicardia ventricular

;

Tratamiento

;

Eficacia tratamiento

;

Quimioterapia

;

Amiodarona

;

Estudio comparativo

;

Iodo Compuesto orgánico

;

America del norte

;

America

;

Reanimación cardiocirculatoria

;

Tratamiento instrumental

;

Salud pública

;

Aparato circulatorio patología

;

Cardiopatía

;

Arritmia

;

Trastorno excitabilidad

;

Antiarrítmico

;

Localisation / Location

INIST-CNRS, Cote INIST : 5907, 35400009803678.0100

Nº notice refdoc (ud4) : 925040



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