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Health Agencies Update
October 16, 2002

Defibrillators Add to Life

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JAMA. 2002;288(15):1838. doi:10.1001/jama.288.15.1838-JHA20010-2-1

Implanted heart defibrillators added a year to the lives of people with irregular heart rhythms, concludes an 8-year study funded by the Agency for Healthcare Research and Quality. The devices sense abnormal heartbeats and shock the heart back to a steady pace.

Investigators tracked mortality and health care costs in a nationwide sample of 7600 elderly Medicare patients, matched according to illness severity and prognosis. Half received a defibrillator and half received usual medical care. Significantly fewer of the defibrillator group had died at 1 year (11% vs 19%), 2 years (20% vs 30%), and 3 years (28% vs 39%). The defibrillator advantage declined during the last 5 years of the study, but overall median survival time for the defibrillator group was longer (5.7 vs 4.6 years). Conducted by researchers at Stanford University School of Medicine, the study also reported that implanted defibrillators cost more than usual care ($48 700 vs $17 000 during the first year; $78 700 vs $37 200 over 8 years). The authors wrote that this works out to "a cost-effectiveness ratio of $78 400 per life-year gained." Although this mark is higher than "a common benchmark of $50 000 per life-year saved, it is comparable to several other commonly accepted medical interventions" (Am J Med. 2002;112:519-527).

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