Christopher A Healy1, Roger G Carrillo2. 1. Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: healycr@gmail.com. 2. Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida.
Abstract
BACKGROUND: Prevention of sudden cardiac arrest (SCA) after removal of an infected implantable cardioverter-defibrillator (ICD) is a challenging clinical dilemma. The cost-effectiveness of the wearable cardioverter-defibrillator (WCD) in this setting remains uncertain. OBJECTIVE: The purpose of this study was to compare the cost-effectiveness of the WCD with discharge home, discharge to a skilled nursing facility, or inpatient monitoring for the prevention of SCA after infected ICD removal. METHODS: A decision model was developed to compare the cost-effectiveness of use of the WCD to several different strategies for patients who undergo ICD removal. One-way and 2-way sensitivity analyses were performed to account for uncertainties. RESULTS: In the base-case analysis, the incremental cost-effectiveness of the WCD strategy was $20,300 per life-year (LY) or $26,436 per quality-adjusted life-year (QALY) compared to discharge home without a WCD. Discharge to a skilled nursing facility and in-hospital monitoring resulted in higher costs and worse clinical outcomes. The incremental cost-effectiveness ratio was as low as $15,392/QALY if the WCD successfully terminated 95% of SCA events and exceeded the $50,000/QALY willingness-to-pay threshold if the efficacy was <69%.The WCD strategy remained cost-effective, assuming 5.6% 2-month SCA risk, as long as the time to reimplantation was at least 2 weeks. CONCLUSION: The WCD likely is cost-effective in protecting patients against SCA after infected ICD removal while waiting for ICD reimplantation compared to keeping patients in the hospital or discharging them home or to a skilled nursing facility.
BACKGROUND: Prevention of sudden cardiac arrest (SCA) after removal of an infected implantable cardioverter-defibrillator (ICD) is a challenging clinical dilemma. The cost-effectiveness of the wearable cardioverter-defibrillator (WCD) in this setting remains uncertain. OBJECTIVE: The purpose of this study was to compare the cost-effectiveness of the WCD with discharge home, discharge to a skilled nursing facility, or inpatient monitoring for the prevention of SCA after infected ICD removal. METHODS: A decision model was developed to compare the cost-effectiveness of use of the WCD to several different strategies for patients who undergo ICD removal. One-way and 2-way sensitivity analyses were performed to account for uncertainties. RESULTS: In the base-case analysis, the incremental cost-effectiveness of the WCD strategy was $20,300 per life-year (LY) or $26,436 per quality-adjusted life-year (QALY) compared to discharge home without a WCD. Discharge to a skilled nursing facility and in-hospital monitoring resulted in higher costs and worse clinical outcomes. The incremental cost-effectiveness ratio was as low as $15,392/QALY if the WCD successfully terminated 95% of SCA events and exceeded the $50,000/QALY willingness-to-pay threshold if the efficacy was <69%.The WCD strategy remained cost-effective, assuming 5.6% 2-month SCA risk, as long as the time to reimplantation was at least 2 weeks. CONCLUSION: The WCD likely is cost-effective in protecting patients against SCA after infected ICD removal while waiting for ICD reimplantation compared to keeping patients in the hospital or discharging them home or to a skilled nursing facility.
Authors: Tobias C Dreher; Ibrahim El-Battrawy; Susanne RÖger; Stephanie L Rosenkaimer; Stefan Gerhards; JÜrgen Kuschyk; Martin Borggrefe; Ibrahim Akin Journal: In Vivo Date: 2020 Nov-Dec Impact factor: 2.155
Authors: L Castro; S Pecha; M Linder; J Vogler; N Gosau; C Meyer; S Willems; H Reichenspurner; S Hakmi Journal: J Cardiothorac Surg Date: 2017-11-25 Impact factor: 1.637
Authors: David Duncker; Ralf Westenfeld; Torsten Konrad; Tobias Pfeffer; Carlos A Correia de Freitas; Roman Pfister; Dierk Thomas; Alexander Fürnkranz; René P Andrié; Andreas Napp; Jörn Schmitt; Laszlo Karolyi; Reza Wakili; Denise Hilfiker-Kleiner; Johann Bauersachs; Christian Veltmann Journal: Clin Res Cardiol Date: 2017-03-08 Impact factor: 5.460