Oregon Health and Science University, School of Medicine, Portland, Oregon.
Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon.
Heart Rhythm. 2020 Aug;17(8):1328-1334. doi: 10.1016/j.hrthm.2020.03.018. Epub 2020 Mar 29.
Children at high risk for sudden cardiac death (SCD) (>6% over 5 years) receive an implantable cardioverter-defibrillator (ICD), but no guidelines are available for those at lower risk. For children at intermediate risk for SCD (4%-6% over 5 years), the utility and cost-effectiveness of in-home automated external defibrillators (AEDs) are unclear.
The purpose of this study was to assess the cost-effectiveness of in-home AED for children at intermediate risk for SCD.
Using hypertrophic cardiomyopathy (HCM) as the proxy disease, a theoretical cohort of 1550 ten-year-old children with HCM was followed for 69 years. Baseline annual risk of SCD was 0.8%. Outcomes were SCD, severe neurologic morbidity (SNM), cost, and quality-adjusted life-years (QALYs). Model inputs were derived from the literature, with a willingness-to-pay threshold of $100,000 per QALY.
Among children at intermediate risk for SCD, in-home AED resulted in 31 fewer cases of SCD but 3 more cases of SNM. There were 319 QALYs gained. Although costs were higher by $28 million, the incremental cost-effectiveness ratio was $86,458, which is below the willingness-to-pay threshold.
For children at intermediate risk for SCD and HCM, in-home AED is cost-effective, resulting in fewer deaths and increased QALYS for a cost below the willingness-to-pay threshold. These findings highlight the economic benefits of in-home AED use in this population.
患有高危性心搏停止（SCD）的儿童（5 年内风险超过 6%）会植入心律转复除颤器（ICD），但对于低危患者并无相关指导方针。对于 SCD 风险处于中间值的儿童（5 年内风险为 4%-6%），家庭使用的自动体外除颤器（AED）的实用性和成本效益尚不清楚。
本研究旨在评估家庭使用 AED 对 SCD 风险处于中间值的儿童的成本效益。
以肥厚型心肌病（HCM）为例，对 1550 名十岁患有 HCM 的儿童进行了 69 年的理论队列随访。SCD 的基线年风险为 0.8%。结局指标包括 SCD、严重神经功能障碍（SNM）、成本和质量调整生命年（QALY）。模型输入数据来源于文献，支付意愿阈值为每 QALY 10 万美元。
在 SCD 风险处于中间值的儿童中，家庭使用 AED 可使 SCD 减少 31 例，但 SNM 增加 3 例。获得 319 个 QALY。尽管成本增加了 2800 万美元，但增量成本效益比为 86458 美元，低于支付意愿阈值。
对于患有 HCM 且 SCD 风险处于中间值的儿童，家庭使用 AED 具有成本效益，可减少死亡人数并增加 QALY，成本低于支付意愿阈值。这些发现突显了家庭使用 AED 对这一人群的经济效益。
