Discussion on the paper:

Cost-Effectiveness of Implantable CardioverterDefibrillators

Main question and motivation

Efficacy of implantable cardioverterdefibrillator (ICD) in increasing survival among patients who are at risk for sudden death due to left ventricular systolic dysfunction but who have not had a life threatening ventricular arrhythmia Very few patients in the United States survive an out-of-hospital cardiac arrest Authors include patients costs and benefits ICD implantation is compared only with the control therapy. Authors do not provide any details about the control therapy, except mentioning that there some heterogeneity in its quality.

Efficiency and costs

Eight clinical trials have randomly assigned patients at risk for sudden death due who have not had life threatening ventricular arrhythmias to receive an ICD or an alternative therapy. Authors project that the implantation of an ICD adds between 2.12 and 6.21 undiscounted years of life. 6 randomized trials showed reduction in mortality associated with the implantation of an ICD with cost-effectiveness ratio of less than $71,000 per QALY gained. 2 studies showed higher mortality rate among patients who received an ICD than among patients who received control therapy.

Costs and benefits

Authors included the costs of
of the initial ICD implantation; of ongoing therapy for both the control and ICD groups; visits to physicians, laboratory tests, and rehospitalization; replacement of ICD generator or lead

All costs are updated to 2005 U.S. dollars using the gross domestic product deflator Authors estimate benefits using specifically adopted Markov decision model. Authors discount all numbers using discount rate equals 3%

Statistical technic and significance

Authors do not provide any details on statistical estimation technic Also they say nothing about number of observations and statistical significance of the estimates.