Anderson M H, Camm A J
St George's Hospital Medical School, London.
Br Heart J. 1993 Jan;69(1):83-92. doi: 10.1136/hrt.69.1.83.
To develop a model to assess the cost-efficacy of the implantable cardioverter defibrillator to prevent sudden death. The model must be sufficiently flexible to allow the use of cost and survival figures derived from different sources.
The study was conducted in a teaching hospital department of cardiology with experience of 40 implantable cardioverter defibrillator implants and a large database of over 500 survivors of myocardial infarction.
The basic costs of screening tests, stay in hospital, and purchase of implantable cardioverter defibrillators were derived from St George's Hospital during 1991. To assess the cost-efficacy of various strategies for the use of implantable cardioverter defibrillators, survival data taken from published studies or from our own database. Implications of the national cost of the various strategies were calculated by estimating the number of patients a year requiring implantation of a defibrillator if the strategy was adopted.
Use of implantable cardioverter defibrillators in survivors of cardiac arrest costs between 22,400 pounds and 57,000 pounds for each year of life saved. Most of the strategies proposed by the current generation of implantable cardioverter defibrillator trials have cost efficacies in the same range, and adoption of any one of these strategies in the United Kingdom could cost between 2 million pounds and 100 million pounds a year. Future technical and medical developments mean that cost-efficacy may be improved by up to 80%. Due to the limitations of screening tests currently available restriction on the use of implantable cardioverter defibrillators to those groups where it seems highly cost-effective will result in a small impact on overall mortality from sudden cardiac death.
Present and possible future applications of the implantable cardioverter defibrillator seem expensive when compared with currently accepted treatments. Technical and medical developments are, however, likely to result in a dramatic improvement in cost efficacy over the next few years.
建立一个模型来评估植入式心脏复律除颤器预防猝死的成本效益。该模型必须足够灵活，以允许使用来自不同来源的成本和生存数据。
该研究在一家教学医院的心脏病科进行，该科室有40例植入式心脏复律除颤器植入经验，并有一个超过500名心肌梗死幸存者的大型数据库。
筛查试验、住院和购买植入式心脏复律除颤器的基本成本来自1991年的圣乔治医院。为了评估使用植入式心脏复律除颤器的各种策略的成本效益，生存数据取自已发表的研究或我们自己的数据库。通过估计如果采用该策略每年需要植入除颤器的患者数量，计算各种策略的国家成本影响。
在心脏骤停幸存者中使用植入式心脏复律除颤器，每挽救一年生命的成本在22400英镑至57000英镑之间。当前一代植入式心脏复律除颤器试验提出的大多数策略的成本效益都在同一范围内，在英国采用这些策略中的任何一种每年可能花费200万英镑至1亿英镑。未来的技术和医学发展意味着成本效益可能提高多达80%。由于目前可用筛查试验的局限性，将植入式心脏复律除颤器的使用限制在那些似乎具有高成本效益的人群中，对心脏性猝死的总体死亡率影响较小。
与目前公认的治疗方法相比，植入式心脏复律除颤器目前及未来可能的应用似乎成本高昂。然而，技术和医学发展可能会在未来几年导致成本效益的显著提高。
