Long-term cost-effectiveness of alternative management strategies for patients with life-threatening ventricular arrhythmias

Mark A. Hlatky*, Derek B. Boothroyd, Iain M. Johnstone, Frank I. Marcus, Elizabeth Hahn, Vernon Hartz, Jay W. Mason

*Corresponding author for this work

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Serial antiarrhythmic drug testing guided by Holter monitoring and electrophysiologic study had similar clinical outcomes in the Electrophysiologic Study versus Electrocardiographic Monitoring (ESVEM) trial, while patients treated with sotalol had improved outcomes. The purpose of this study was to compare long-term cost effectiveness of these management alternatives. Methods: Patients in the ESVEM trial were linked to computerized files of either the Health Care Finance Administration or the Department of Veterans Affairs. Total hospital costs and survival time over five year follow-up were measured using actuarial methods, and cost-effectiveness was calculated. Results: Patients randomized to therapy guided by electrophysiologic study had more hospital admissions, higher costs, and a cost-effectiveness ratio of $162,500 per life year added compared with therapy guided by Holter monitoring. Patients randomized to sotalol had fewer hospitalizations, lower costs, and better survival than patients randomized to other drugs, and sotalol was a dominant strategy in the cost effectiveness analysis. Patients for whom an effective drug was found had fewer hospital admissions, lower costs, and longer survival. These findings were robust in sensitivity analyses and in bootstrap replications. Conclusions: Serial drug testing guided by electrophysiologic study had an unfavorable cost-effectiveness ratio relative to Holter monitoring, while sotalol was cost effective relative to other antiarrhythmic drugs.

Original languageEnglish (US)
Pages (from-to)185-193
Number of pages9
JournalJournal of Clinical Epidemiology
Volume50
Issue number2
DOIs
StatePublished - Jan 1 1997

Fingerprint

Cost-Benefit Analysis
Sotalol
Cardiac Arrhythmias
Ambulatory Electrocardiography
Costs and Cost Analysis
Anti-Arrhythmia Agents
Survival
Pharmaceutical Preparations
Hospital Costs
Veterans
Hospitalization
Delivery of Health Care
Therapeutics

Keywords

  • Ambulatory ECG monitoring
  • Cost-effectiveness analysis
  • Electrophysiologic testing
  • Randomized trial
  • Sotalol
  • Ventricular arrhythmia

ASJC Scopus subject areas

  • Epidemiology

Cite this

Hlatky, Mark A. ; Boothroyd, Derek B. ; Johnstone, Iain M. ; Marcus, Frank I. ; Hahn, Elizabeth ; Hartz, Vernon ; Mason, Jay W. / Long-term cost-effectiveness of alternative management strategies for patients with life-threatening ventricular arrhythmias. In: Journal of Clinical Epidemiology. 1997 ; Vol. 50, No. 2. pp. 185-193.
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Long-term cost-effectiveness of alternative management strategies for patients with life-threatening ventricular arrhythmias. / Hlatky, Mark A.; Boothroyd, Derek B.; Johnstone, Iain M.; Marcus, Frank I.; Hahn, Elizabeth; Hartz, Vernon; Mason, Jay W.

In: Journal of Clinical Epidemiology, Vol. 50, No. 2, 01.01.1997, p. 185-193.

Research output: Contribution to journalArticle

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T1 - Long-term cost-effectiveness of alternative management strategies for patients with life-threatening ventricular arrhythmias

AU - Hlatky, Mark A.

AU - Boothroyd, Derek B.

AU - Johnstone, Iain M.

AU - Marcus, Frank I.

AU - Hahn, Elizabeth

AU - Hartz, Vernon

AU - Mason, Jay W.

PY - 1997/1/1

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N2 - Background: Serial antiarrhythmic drug testing guided by Holter monitoring and electrophysiologic study had similar clinical outcomes in the Electrophysiologic Study versus Electrocardiographic Monitoring (ESVEM) trial, while patients treated with sotalol had improved outcomes. The purpose of this study was to compare long-term cost effectiveness of these management alternatives. Methods: Patients in the ESVEM trial were linked to computerized files of either the Health Care Finance Administration or the Department of Veterans Affairs. Total hospital costs and survival time over five year follow-up were measured using actuarial methods, and cost-effectiveness was calculated. Results: Patients randomized to therapy guided by electrophysiologic study had more hospital admissions, higher costs, and a cost-effectiveness ratio of $162,500 per life year added compared with therapy guided by Holter monitoring. Patients randomized to sotalol had fewer hospitalizations, lower costs, and better survival than patients randomized to other drugs, and sotalol was a dominant strategy in the cost effectiveness analysis. Patients for whom an effective drug was found had fewer hospital admissions, lower costs, and longer survival. These findings were robust in sensitivity analyses and in bootstrap replications. Conclusions: Serial drug testing guided by electrophysiologic study had an unfavorable cost-effectiveness ratio relative to Holter monitoring, while sotalol was cost effective relative to other antiarrhythmic drugs.

AB - Background: Serial antiarrhythmic drug testing guided by Holter monitoring and electrophysiologic study had similar clinical outcomes in the Electrophysiologic Study versus Electrocardiographic Monitoring (ESVEM) trial, while patients treated with sotalol had improved outcomes. The purpose of this study was to compare long-term cost effectiveness of these management alternatives. Methods: Patients in the ESVEM trial were linked to computerized files of either the Health Care Finance Administration or the Department of Veterans Affairs. Total hospital costs and survival time over five year follow-up were measured using actuarial methods, and cost-effectiveness was calculated. Results: Patients randomized to therapy guided by electrophysiologic study had more hospital admissions, higher costs, and a cost-effectiveness ratio of $162,500 per life year added compared with therapy guided by Holter monitoring. Patients randomized to sotalol had fewer hospitalizations, lower costs, and better survival than patients randomized to other drugs, and sotalol was a dominant strategy in the cost effectiveness analysis. Patients for whom an effective drug was found had fewer hospital admissions, lower costs, and longer survival. These findings were robust in sensitivity analyses and in bootstrap replications. Conclusions: Serial drug testing guided by electrophysiologic study had an unfavorable cost-effectiveness ratio relative to Holter monitoring, while sotalol was cost effective relative to other antiarrhythmic drugs.

KW - Ambulatory ECG monitoring

KW - Cost-effectiveness analysis

KW - Electrophysiologic testing

KW - Randomized trial

KW - Sotalol

KW - Ventricular arrhythmia

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