LONG-TERM COST-EFFECTIVENESS OF ALTERNATIVE MANAGEMENT STRATEGIES FORPATIENTS WITH LIFE-THREATENING VENTRICULAR ARRHYTHMIAS

Background: Serial antiarrhythmic drug testing guided by Holter monito ring and electrophysiologic study had similar clinical outcomes in the Electrophysiologic Study versus Electrocardiographic Monitoring (ESVE M) trial, while patients treated with sotalol had improved outcomes. T he purpose of this study was to compare long-term cost-effectiveness o f these management alternatives. Methods: Patients in the ESVEM trial were linked to computerized files of either the Health Care Finance Ad ministration or the Department of Veterans Affairs. Total hospital cos ts and survival time over five year follow-up were measured using actu arial methods, and cost-effectiveness was calculated. Results: Patient s randomized to therapy guided by electrophysiologic study had more ho spital admissions, higher costs, and a cost-effectiveness ratio of $16 2,500 per life year added compared with therapy guided by Holter monit oring. Patients randomized to sotalol had fewer hospitalizations, lowe r costs, and better survival than patients randomized to other drugs, and sotalol was a dominant strategy in the cost-effectiveness analysis . Patients for whom an effective drug was found had fewer hospital adm issions, lower costs, and longer survival. These findings were robust in sensitivity analyses and in bootstrap replications. Conclusions: Se rial drug testing guided by electrophysiologic study had an unfavorabl e cost-effectiveness ratio relative to Holter monitoring, while sotalo l was cost-effective relative to other antiarrhythmic drugs. Copyright (C) 1997 Elsevier Science Inc.