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Presentation Number:
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413-6
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Abstract Title:
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Cost-Effectiveness of ICD Therapy and Risk Stratification With
Microvolt T Wave Alternans Testing in the MADIT-II Eligible Population
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Presentation Start/End Time:
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Monday, Mar 13, 2006, 2:15 PM - 2:30 PM
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Topic:
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Defibrillation/Implantable Antiarrhythmia Devices
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Author Block:
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Paul S. Chan, Kenneth M. Stein,
Theodore Chow, Mark Fendrick, J. Thomas Bigger, Jr., Sandeep Vijan,
University of Michigan Medical Center, Ann Arbor, MI, Ohio Heart and
Vascular Center, Cincinnati, OH
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Background: Implantable
Cardioverter-Defibrillators (ICDs) have been shown to prevent mortality in
the MADIT-II population. Microvolt T-Wave Alternans (MTWA) testing has been
shown to be effective in risk stratifying MADIT-II eligible patients at
risk for death.
Objectives: To compare the cost-effectiveness of ICD placement with
and without risk stratification with MTWA testing in the MADIT-II
population.
Methods: Based on published data and hospital accounting
information, cost-effectiveness of 3 therapeutic strategies in MADIT-II
eligible patients were assessed using a Markov model: 1) ICD placement in
all; 2) ICD placement in patients who test non-negative with MTWA testing;
and 3) medical management. Outcomes of expected cost, quality-adjusted life
years (QALYs), and incremental cost-effectiveness were determined for
patient lifetime.
Results: Under base-case assumptions, providing ICDs only to those
who test MTWA non-negative produced a gain of 1.12 QALYs at an incremental
cost of $60,100 when compared to medical therapy, resulting in an
incremental cost-effectiveness ratio of $53,900/QALY. When compared with a
MTWA risk stratification strategy, placing ICDs in all patients resulted in
an incremental cost-effectiveness ratio of $96,700/QALY. 82% of the total
potential benefit of ICDs was achieved by implanting ICDs in the 67% of
patients who tested MTWA non-negative. Results were most sensitive to the
effectiveness of MTWA as a risk stratification tool, MTWA negative screen
rate, cost and efficacy of ICD therapy, cost of annual care, and patient
risk for arrhythmic death.
Conclusion: Risk stratification with MTWA testing in MADIT-II
patients improves the cost-effectiveness of ICDs. Implanting defibrillators
in all MADIT-II type patients, however, is not cost-effective, with
one-third of patients deriving little additional benefit at great expense.
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Commercial Relationship:
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P.S. Chan, None; K.M. Stein, None; T.
Chow, Medtronic, Modest,I - Research Grants ; M. Fendrick,
None; J. Bigger, None; S. Vijan, None.
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