Journal of Clinical Epidemiology
Volume 50, Issue 2 , Pages 185-193, February 1997

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

  • Mark A. Hlatky

      Affiliations

    • Corresponding Author InformationAddress for correspondence: and reprints: Mark Hlatky, M.D., Stanford University School of Medicine, HRP Redwood Building, Room 150, Stanford, CA 94305-5092.
    • Department of Health Research and Policy and Department of Medicine, Stanford University School of Medicine, Stanford, California 94305-5092 U.S.A.
    • ,
  • Derek B. Boothroyd

      Affiliations

    • Department of Health Research and Policy and Department of Medicine, Stanford University School of Medicine, Stanford, California 94305-5092 U.S.A.
    • ,
  • Iain M. Johnstone

      Affiliations

    • Department of Health Research and Policy and Department of Medicine, Stanford University School of Medicine, Stanford, California 94305-5092 U.S.A.
    • ,
  • Frank I. Marcus

      Affiliations

    • Department of Medicine, University of Arizona School of Medicine, Tucson, Arizona 85724 U.S.A.
    • ,
  • Elizabeth Hahn

      Affiliations

    • Department of Medicine, University of Arizona School of Medicine, Tucson, Arizona 85724 U.S.A.
    • ,
  • Vernon Hartz

      Affiliations

    • Department of Medicine, University of Arizona School of Medicine, Tucson, Arizona 85724 U.S.A.
    • ,
  • Jay W. Mason

      Affiliations

    • Department of Medicine, University of Utah School of Medicine, Salt lake City, Utah 84132 U.S.A.

Accepted 4 September 1996.

for the ESVEM Investigators

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.

Keywords:  Randomized trial, cost-effectiveness analysis, ventricular arrhythmia, sotalol, electrophysiologic testing, ambulatory ECG monitoring

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☆ Presented in part at the meeting of the American Federation for Clinical Research, May 1993. Refer to [5] which has an Appendix listing the ESVEM Investigators.

☆☆ Supported by a grant from Bristol-Meyers Squibb Company, Princeton, New Jersey, and Grant HL-34071 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. Additional support from Knoll Pharmaceuticals, Whippany, New Jersey; Boehringer-Ingleheim Corporation, Ridgefield, Connecticut; Ciba-Geigy Corporation, Summit, New Jersey; Grant RR-00064 from the National Center for Research Resources, Bethesda, Maryland; and the Robert Wood Johnson Foundation, Princeton, New Jersey.

PII: S0895-4356(96)00331-9

Journal of Clinical Epidemiology
Volume 50, Issue 2 , Pages 185-193, February 1997

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