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Appropriate use of the implantable cardioverter defibrillator: a Canadian perspective. Canadian Working Group on Cardiac Pacing.

https://arctichealth.org/en/permalink/ahliterature203131
Source
Pacing Clin Electrophysiol. 1999 Jan;22(1 Pt 1):1-4
Publication Type
Article
Date
Jan-1999

Should the implantable cardiac defibrillator be used for primary prevention of sudden death? A review of the issues relevant to hospital decision making.

https://arctichealth.org/en/permalink/ahliterature177860
Source
Can J Cardiol. 2004 Oct;20(12):1199-204
Publication Type
Article
Date
Oct-2004
Author
Maurice McGregor
Jun Chen
Author Affiliation
The McGill University Health Centre, Montreal, Quebec, Canada. maurice.mcgregor@mcgill.ca
Source
Can J Cardiol. 2004 Oct;20(12):1199-204
Date
Oct-2004
Language
English
Publication Type
Article
Keywords
Budgets
Cost-Benefit Analysis
Death, Sudden - prevention & control
Decision Making, Organizational
Defibrillators, Implantable - economics - utilization
Ethics, Institutional
Female
Hospital Administration - economics - ethics
Hospital Costs
Humans
Male
Organizational Policy
Primary Prevention - economics - methods
Quality of Life
Quebec
Risk assessment
Technology Assessment, Biomedical - economics - ethics
Abstract
New evidence suggests that the implantable cardiac defibrillator (ICD) may be effective for primary prevention of sudden death. High instrumental cost and the potentially large number of candidates will significantly impact hospital budgets.
To review the information relevant to hospital policy decisions on the use of ICDs for primary prevention.
Modelling based on an evaluation of reported studies and Canadian costs, detailed in a comprehensive review available at .
Health outcomes: Two high-quality primary prevention trials suggest a reduction in annual mortality of 2.9% with bounds of probability (PB) of 2.0% to 3.8%, in early years. To undertake 100 implants per year may result in an increasing annual saving of life-years of acceptable quality, stabilizing by 15 years at 110 (PB 72 to 154) each year. Economic impact: The annual costs would stabilize at 15 years at approximately 4.3 million dollars. Cost-effectiveness: The incremental cost-effectiveness from the point of view of the health care system would be approximately 47,000 dollars (PB 35,000 dollars to 70,000 dollars), discounted at 3%. Ethical and legal issues: The decision should not be individual but institutional, using a process that is transparent, consistent and fair.
The ICD can prolong life, with acceptable quality. Restriction of its use would be solely on grounds of expense.
PubMed ID
15494771 View in PubMed
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