Publications [#197773] of Daniel B. Mark

Papers Published

1. DB Mark, CL Nelson, KJ Anstrom, SM Al-Khatib, AA Tsiatis, PA Cowper, NE Clapp-Channing, L Davidson-Ray, JE Poole, G Johnson, J Anderson, KL Lee, GH Bardy, SCD-HeFT Investigators, Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)., Circulation, vol. 114 no. 2 (July, 2006), pp. 135-42, ISSN 1524-4539 [doi]
   (last updated on 2011/11/29)

   Abstract:
   BACKGROUND: In the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), implantable cardioverter-defibrillator (ICD) therapy significantly reduced all-cause mortality rates compared with medical therapy alone in patients with stable, moderately symptomatic heart failure, whereas amiodarone had no benefit on mortality rates. We examined long-term economic implications of these results. RESULTS: Medical costs were estimated by using hospital billing data and the Medicare Fee Schedule. Our base case cost-effectiveness analysis used empirical clinical and cost data to estimate the lifetime incremental cost of saving an extra life-year with ICD therapy relative to medical therapy alone. At 5 years, the amiodarone arm had a survival rate equivalent to that of the placebo arm and higher costs than the placebo arm. For ICD relative to medical therapy alone, the base case lifetime cost-effectiveness and cost-utility ratios (discounted at 3%) were dollar 38,389 per life-year saved (LYS) and dollar 41,530 per quality-adjusted LYS, respectively. A cost-effectiveness ratio < dollar 100,000 was obtained in 99% of 1000 bootstrap repetitions. The cost-effectiveness ratio was sensitive to the amount of extrapolation beyond the empirical 5-year trial data: dollar 127,503 per LYS at 5 years, dollar 88,657 per LYS at 8 years, and dollar 58,510 per LYS at 12 years. Because of a significant interaction between ICD treatment and New York Heart Association class, the cost-effectiveness ratio was dollar 29,872 per LYS for class II, whereas there was incremental cost but no incremental benefit in class III. CONCLUSIONS: Prophylactic use of single-lead, shock-only ICD therapy is economically attractive in patients with stable, moderately symptomatic heart failure with an ejection fraction < or = 35%, particularly those in NYHA class II, as long as the benefits of ICD therapy observed in the SCD-HeFT persist for at least 8 years.

   Keywords:
   Adult • Cost-Benefit Analysis • Death, Sudden, Cardiac* • Defibrillators, Implantable • Electroshock • Equipment Design • Heart Failure • Humans • Medical Records • Randomized Controlled Trials as Topic • Retrospective Studies • Treatment Outcome • United States • economics • economics* • epidemiology • surgery*