Cost-effectiveness analysis of preventing sudden cardiac death with an implantable cardioverter defibrillator versus amiodarone

Sudden cardiac death is natural death caused by previous heart disease, when within an hour from the onset of symptoms ensue loss of consciousness and cessation of circulation. Many studies have confirmed that malignant ventricular arrhythmias are the most common cause of sudden cardiac death. Alternatives for prevention of sudden cardiac death are antiarrhythmic drug treatment, primarily amiodarone, and implantation of cardioverter defibrillator. The aim of this pharmacoeconomic study was to compare the cost-effectiveness of implantable cardioverter defibrillator and amiodarone in preventing sudden cardiac death. The Markov model was designed based on data from the literature, and analyzed using the software TreeAge®. The time horizon was five years. The duration of one cycle was one month. Effect for each model state was expressed in quality-adjusted life years gained (QALYs). The Monte Carlo simulation was used for 1.000 hypothetical patients. Implantation of cardioverter defibrillator proved to be pharmacoeconomically inferior method of preventing sudden cardiac death, nearly twelve times more expensive than applying amiodarone, i.e. 621.833,18 dinars per QALY gained in comparison to 52.644,25 dinars per QALY gained for amiodarone. The study showed that the method with superior cost/effectiveness ratio was preventing sudden cardiac death by amiodarone. It is expected that further research will indicate a subpopulation in which the implantable cardioverter defibrillator will show better cost/effectiveness ratio than amiodarone