Cost-effectiveness of in-home automated external defibrillators for children with cardiac conditions associated with risk of sudden cardiac death

Meredith B. Haag, Alyssa R. Hersh, David E. Toffey, James A. Sargent, Eric C. Stecker, Stephen Heitner, Aaron B. Caughey, Seshadri Balaji

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    1 Scopus citations

    Abstract

    Background: 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. Objective: The purpose of this study was to assess the cost-effectiveness of in-home AED for children at intermediate risk for SCD. Methods: 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. Results: 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. Conclusion: 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.

    Original languageEnglish (US)
    Pages (from-to)1328-1334
    Number of pages7
    JournalHeart Rhythm
    Volume17
    Issue number8
    DOIs
    StatePublished - Aug 2020

    Keywords

    • Automated external defibrillator
    • Children
    • Cost-effectiveness analysis
    • Implantable cardioverter–defibrillator
    • Sudden cardiac death

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Physiology (medical)

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