Cost-Effectiveness of Implantable Cardioverter-Defibrillators in Children with Cardiac Conditions Associated with Risk f
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ORIGINAL ARTICLE
Cost‑Effectiveness of Implantable Cardioverter‑Defibrillators in Children with Cardiac Conditions Associated with Risk for Sudden Cardiac Death Meredith B. Haag1 · Alyssa R. Hersh2 · David E. Toffey3 · James A. Sargent4 · Eric C. Stecker5 · Stephen B. Heitner5 · Aaron B. Caughey2 · Seshadri Balaji1,6 Received: 14 January 2020 / Accepted: 12 June 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Children at high risk for sudden cardiac death (SCD) receive implantable cardioverter-defibrillators (ICD) for prevention, but the cost effectiveness of ICDs in children at intermediate risk is unclear. Our objective was to create a cost-effectiveness model to compare costs and outcomes in children at risk of SCD, with and without ICD. Utilizing hypertrophic cardiomyopathy as the proxy disease, a theoretical cohort of 8150 children was followed for 69 years. Model inputs were derived from the literature, with an incremental cost-effectiveness ratio (ICER) willingness-to-pay threshold of $100,000/quality-adjusted life year (QALY) used to delineate cost effectiveness. Outcomes included prevalence of severe neurological morbidity (SNM), SCD, cost, and QALYs. In children at intermediate risk of SCD (4–6% over 5 years), ICD resulted in 56 fewer cases of SNM, 2686 fewer deaths. In children at high risk (> 6% over 5 years), ICD placement resulted in 74 fewer cases of SNM and 3663 fewer deaths from cardiac causes. The costs of ICD were higher, but placement was cost effective with an ICER of $3009 per QALY in intermediate risk children, but ICD therapy was a dominant strategy in high-risk children. Sensitivity analysis demonstrated ICD placement was cost-effective until the annual probability of SCD was 6% over 5 years, typically receive implantable cardioverter-defibrillators (ICD) for prevention [1]. In those patients considered to be at intermediate risk (4–6% over 5 years), European Society of Cardiology guidelines indicate that ICD implant “may be considered” [2]. One aspect that may impact the decision is the cost-effectiveness of ICD implantation. Therefore, it is important to ascertain the cost effectiveness of ICD placement in children. ICD’s are effective at terminating life-threatening ventricular tachyarrhythmias, but the substantial cost of the device and high rate of complications over a lifetime complicate the decision regarding the pediatric patients for whom it is most appropriate [3, 4]. While the cost effectiveness of
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ICD placement has been investigated in the adult population, no such study exists in the pediatric population, which is distinct given the long timeline over which both costs and quality-adjusted life years (QALYs) accrue [4]. Therefore, we sought to examine the cost effectiveness of ICD placement in children in the United States at risk of sudden cardiac death.
Methods We created a Markov model using TreeAge Pro software (2019 version; TreeAge Software Inc, Williamstown, MA) to estimate the cost effective
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