Cost-effectiveness of in-home automated external defibrillators for children with cardiac conditions associated with risk of sudden cardiac death

• Published in: Heart rhythm Vol. 17; no. 8; pp. 1328 - 1334
• Main Authors: Haag, Meredith B., Hersh, Alyssa R., Toffey, David E., Sargent, James A., Stecker, Eric C., Heitner, Stephen B., Caughey, Aaron B., Balaji, Seshadri
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2020
• Subjects: Automated external defibrillator; Children; Cost-effectiveness analysis; Implantable cardioverter–defibrillator; Sudden cardiac death; Cost-effectiveness analysis; Implantable cardioverter–defibrillator; Children; Sudden cardiac death; Automated external defibrillator
• ISSN: 1547-5271; 1556-3871
• DOI: 10.1016/j.hrthm.2020.03.018

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. The purpose of this study was to assess the cost-effectiveness of in-home AED for children at intermediate risk for SCD. 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. 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. 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.