TY - JOUR
T1 - Cost-effectiveness of in-home automated external defibrillators for children with cardiac conditions associated with risk of sudden cardiac death
AU - Haag, Meredith B.
AU - Hersh, Alyssa R.
AU - Toffey, David E.
AU - Sargent, James A.
AU - Stecker, Eric C.
AU - Heitner, Stephen
AU - Caughey, Aaron B.
AU - Balaji, Seshadri
N1 - Publisher Copyright:
© 2020
PY - 2020/8
Y1 - 2020/8
N2 - 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.
AB - 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.
KW - Automated external defibrillator
KW - Children
KW - Cost-effectiveness analysis
KW - Implantable cardioverter–defibrillator
KW - Sudden cardiac death
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U2 - 10.1016/j.hrthm.2020.03.018
DO - 10.1016/j.hrthm.2020.03.018
M3 - Article
C2 - 32234558
AN - SCOPUS:85087925887
SN - 1547-5271
VL - 17
SP - 1328
EP - 1334
JO - Heart Rhythm
JF - Heart Rhythm
IS - 8
ER -