Long-term cost-effectiveness of alternative management strategies for patients with life-threatening ventricular arrhythmias.
Serial antiarrhythmic drug testing guided hy 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.
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.
Patients randomized to therapy guided hy 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. (...)
Mots-clés Pascal : Trouble rythme cardiaque, Ventricule cardiaque, Homme, Sotalol, Bloquant alpha-adrénergique, Antagoniste, Récepteur alpha-adrénergique, Antiarythmique, Chimiothérapie, Traitement, Etude comparative, Analyse coût efficacité, Economie santé, Electrocardiographie, Appareil circulatoire pathologie, Cardiopathie, Electrodiagnostic, Electrophysiologie, Monitorage
Mots-clés Pascal anglais : Arrhythmia, Heart ventricle, Human, Sotalol, Alpha blocking agent, Antagonist, alpha-Adrenergic receptor, Antiarrhythmic agent, Chemotherapy, Treatment, Comparative study, Cost efficiency analysis, Health economy, Electrocardiography, Cardiovascular disease, Heart disease, Electrodiagnosis, Electrophysiology, Monitoring
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0238678
Code Inist : 002B02F02. Création : 11/06/1997.