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Date of download: 7/10/2016 From: Potential Cost-Effectiveness of Prophylactic Use of the Implantable Cardioverter Defibrillator or Amiodarone after Myocardial.

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Presentation on theme: "Date of download: 7/10/2016 From: Potential Cost-Effectiveness of Prophylactic Use of the Implantable Cardioverter Defibrillator or Amiodarone after Myocardial."— Presentation transcript:

1 Date of download: 7/10/2016 From: Potential Cost-Effectiveness of Prophylactic Use of the Implantable Cardioverter Defibrillator or Amiodarone after Myocardial Infarction Ann Intern Med. 2001;135(10):870-883. doi:10.7326/0003-4819-135-10-200111200-00007 The decision model.The square node on the left represents a choice among three alternative treatments: implantable cardiac defibrillator (ICD), amiodarone, and no antiarrhythmic treatment. Circles represent chance nodes. Patients who receive an ICD are at risk for death from the implant procedure. Patients who do not die of ICD implantation and patients who are receiving amiodarone or no treatment enter the Markov tree (denoted by rectangles containing circles and an arrow). The Markov tree represents the clinical events that can occur during each 1-month period as a patient is followed until death. During each 1-month period, a patient may die from arrhythmic or nonarrhythmic cardiac causes and may also die of noncardiac causes. If none of these events occur, the patient remains well for the 1-month period. Patients who have an ICD may have a lead infection or failure that causes them to withdraw from treatment (and to switch to no antiarrhythmic therapy). Patients who receive amiodarone are at risk for amiodarone toxicity. In our analysis, a patient may die of toxicity, withdraw from treatment (and switch to no antiarrhythmic therapy), or have acute toxicity that does not require discontinuation. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

2 Date of download: 7/10/2016 From: Potential Cost-Effectiveness of Prophylactic Use of the Implantable Cardioverter Defibrillator or Amiodarone after Myocardial Infarction Ann Intern Med. 2001;135(10):870-883. doi:10.7326/0003-4819-135-10-200111200-00007 Sensitivity analysis of cardiac mortality rate.Top. Amiodarone compared with no antiarrhythmic therapy. Bottom. Implantable cardioverter defibrillator (ICD) compared with no antiarrhythmic therapy. Arrows indicate base-case estimates for each sensitivity analysis. Both graphs assume an effectiveness of 60% in reduction in arrhythmic mortality with ICD and an 11% reduction in total mortality with amiodarone therapy. EF = ejection fraction; QALY = quality-adjusted life-year. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

3 Date of download: 7/10/2016 From: Potential Cost-Effectiveness of Prophylactic Use of the Implantable Cardioverter Defibrillator or Amiodarone after Myocardial Infarction Ann Intern Med. 2001;135(10):870-883. doi:10.7326/0003-4819-135-10-200111200-00007 Sensitivity analysis of the incremental cost-effectiveness of an implantable cardiac defibrillator (ICD) compared with amiodarone.Top. Patients with an ejection fraction of 0.3 or less. Middle. Patients with an ejection fraction of 0.31 to 0.4. Bottom. Patients with an ejection fraction greater than 0.4. QALY = quality-adjusted life-year. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

4 Date of download: 7/10/2016 From: Potential Cost-Effectiveness of Prophylactic Use of the Implantable Cardioverter Defibrillator or Amiodarone after Myocardial Infarction Ann Intern Med. 2001;135(10):870-883. doi:10.7326/0003-4819-135-10-200111200-00007 Sensitivity analysis.Top. Incremental cost-effectiveness of an implantable cardiac defibrillator (ICD) compared with no antiarrhythmic therapy. Bottom. Incremental cost-effectiveness of amiodarone compared with no antiarrhythmic therapy. EF = ejection fraction; QALY = quality-adjusted life-year. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians


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