Cost-effectiveness of the implantable cardioverter-defibrillator - Resultsfrom the Canadian Implantable Defibrillator Study (CIDS)

Background-In the Canadian Implantable Defibrillator Study (CIDS), we asses sed the cost-effectiveness of the implantable cardioverter-defibrillator (I CD) in reducing the risk of death in survivors of previous ventricular tach ycardia (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 base d on initial therapy assignment. Incremental cost-effectiveness of ICD ther apy was computed as the ratio of the difference in cost (ICD minus amiodaro ne) to the difference in life expectancy (both discounted at 3% per year). All costs are in 1999 Canadian dollars (C$1 approximate to US$0.65). Over 6 .3 years, mean cost per patient in the ICD group was C$87 715 versus C$38 6 00 in the amiodarone group (difference C$49 115; 95% CI C$25 502 to C$69 50 8). 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-ef fectiveness of ICD therapy of C$213 543 per life-year gained. ICD benefit w as greater in patients with low left ventricular ejection fraction (<35%), and cost-effectiveness in this group was more attractive (C$108 484), Alter native extrapolations of survival benefit and costs to 12 years indicated c ost-effectiveness in the range of C$100 000 to C$150 000 per life-year gain ed. Conclusions-At C$213 543, the value for the money offered by ICD therapy is not attractive by currently accepted standards. Further research is warran ted to identify the indications and patient subgroups for whom ICDs are a c ost-effective use of resources.