Division of Pediatric Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
J Card Fail. 2010 Sep;16(9):734-41. doi: 10.1016/j.cardfail.2010.04.009. Epub 2010 Jun 8.
Implantable cardioverter-defibrillators (ICDs) improve survival and are cost-effective in adults with poor left ventricular function. Because of differences in heart failure etiology, sudden death rates, and ICD complication rates, these findings may not be applicable to children.
We developed a Markov model to compare typical management of childhood dilated cardiomyopathy with symptomatic heart failure to prophylactic ICD implantation plus typical management. Model costs included costs of outpatient care, medications, complications, and transplantation. Time horizon was up to 20 years from model entry. Total costs were $433,000 (ICD strategy) and $355,000 (typical management). Although quality adjusted survival was greater in the ICD group (6.78 versus 6.43 quality adjusted life-years [QALY]), the incremental cost-utility ratio was $281,622/QALY saved with the ICD strategy. In sensitivity analyses, the ICD strategy cost less than the $100,000/QALY benchmark for cost-effectiveness only when the annual probability of sudden death exceeded 13% or when strong, sustained benefits in quality of life from the ICD were assumed.
Prophylactic ICD use in children with dilated cardiomyopathy, poor ventricular function, and symptomatic heart failure does not appear to be cost-effective. This is likely due to lower sudden death rates in this population.
植入式心脏复律除颤器（ICD）可改善左心室功能不良的成年人的存活率并具有成本效益。由于心力衰竭病因、猝死率和 ICD 并发症率的差异，这些发现可能不适用于儿童。
我们开发了一个马尔可夫模型，比较了儿童扩张型心肌病伴症状性心力衰竭的典型治疗与预防性 ICD 植入加典型治疗。模型成本包括门诊护理、药物、并发症和移植的成本。时间范围从模型进入到 20 年。总费用为 433,000 美元（ICD 策略）和 355,000 美元（典型治疗）。尽管 ICD 组的质量调整生存时间更长（6.78 比 6.43 个质量调整生命年[QALY]），但 ICD 策略的增量成本效益比为 281,622 美元/QALY，节省了 ICD 策略。在敏感性分析中，只有当每年猝死的概率超过 13%或假设 ICD 对生活质量有强烈和持续的益处时，ICD 策略的成本才低于 100,000 美元/QALY 的成本效益基准。
在患有扩张型心肌病、心室功能不良和症状性心力衰竭的儿童中预防性使用 ICD 似乎没有成本效益。这可能是由于该人群的猝死率较低。
