LifeVest 'Wearable Defibrillator' a Cost-Effective Bridge After ICD Removal for Infection

April 02, 2015

MIAMI, FL – For patients who have undergone the successful removal of their implantable cardioverter defibrillator (ICD) because of an infection, the use of a wearable cardioverter defibrillator (LifeVest, Zoll) is a cost-effective treatment strategy for preventing sudden cardiac arrest (SCA) while patients wait for another device, according to a new analysis[1].

"The decision regarding when to reimplant must be individualized to each patient and clinical situation," state Drs Christopher Healy and Roger Carrillo (University of Miami Miller School of Medicine, FL). "For many patients, continuous inpatient monitoring may be impossible or at least highly undesirable. The wearable cardioverter defibrillator is likely a cost-effective treatment modality for the prevention of SCA in a significant number of these at-risk patients."

Writing in Heart Rhythm March 31, they note that a patient is typically given antibiotics for several weeks following the extraction of an infected device. If a second device is put in too soon, there is a risk of repeat infection. While the device is out, however, there is a risk of SCA. For the patient, continuous monitoring is impractical and, for the hospital, expensive.

In the present analysis, outpatient use of the wearable defibrillator cost $1805 more but resulted in better clinical outcomes compared with a strategy of discharging the patient home without a wearable or implanted defibrillator. Based on a 5.6% risk of sudden cardiac death within the first 2 months (4.0% risk within the first month), 0.089 life-years were gained with the wearable defibrillator, yielding an incremental cost-effectiveness ratio (ICER) of $26 436 per quality-adjusted life-year (QALY) gained.

As with all economic analyses, the researchers made some assumptions. Their base-case scenario assumed the wearable defibrillator was 84.5% effective in terminating potentially fatal ventricular tachyarrhythmias. If the efficacy of the defibrillator increased to 95%, the ICER was as low as $15 392/QALY. If efficacy declined below 69%, the wearable defibrillator would no longer be considered cost-effective as it would exceed $50 000/QALY.

The wearable defibrillator was also cost-effective as long as the time to reimplantation of the replacement ICD was at least 2 weeks.

In addition, researchers report the wearable device was cheaper than discharging patients to a nursing facility or leaving them in the hospital and also had better clinical outcomes. As a result, the wearable defibrillator was considered a "dominant" strategy against these two treatment options.

Healy had no industry relationships to disclose. Carrillo consults for Spectranetics, Boston Scientific, Sorin, Medtronic, St Jude Medical, and Biotronik; is on the speaker's bureaus of Medtronic, St Jude Medical, Sorin, and Zoll; and has received grant/research support from St Jude Medical and Medtronic.

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