23645
document
Drug therapy of ventricular tachycardia : a cost comparison of randomized noninvasive and invasive approaches . OBJECTIVE Economic evaluation of noninvasive ( suppression of ventricular arrhythmias detected by ambulatory monitoring ) and invasive ( suppression of arrhythmias induced by programmed stimulation ) approaches to antiarrhythmic drug selection for ventricular tachyarrhythmias . DESIGN/SETTING Randomized clinical trial/tertiary-care hospital . PATIENTS Of 124 consecutive patients referred for treatment of symptomatic ventricular tachyarrhythmias , 57 consenting patients were eligible to have drug therapy selected by either noninvasive or invasive approaches . MEASUREMENTS Costs of initial and follow-up ( 26 +/- 15 months ) admissions for the two groups were compared . This economic evaluation also considered relative efficacies of the approaches using the primary outcome variable of symptomatic , sustained ventricular tachyarrhythmia recurrence ( including sudden death ) . RESULTS Initial hospitalization for therapy selection was less costly by the noninvasive approach ( $ 6,869 +/- 4,019 ) than by the invasive approach ( $ 13,164 +/- 6,740 ) ( P less than 0.001 ) . However , the noninvasive approach generated higher follow-up hospital costs ( $ 9,204 +/- 9,217 ) than the invasive approach ( $ 3,784 +/- 4,944 ) ( P = 0.01 ) . Thus , total hospital costs of the noninvasive ( $ 16,073 +/- 9,423 ) and invasive approaches ( $ 16,949 +/- 7,174 ) were equivalent . The two-year actuarial probability of a recurrent , sustained , symptomatic ventricular tachyarrhythmia was greater in noninvasive ( 0.50 +/- 0.10 ) than in invasive ( 0.20 +/- 0.08 ) approach patients ( P = 0.02 ) . CONCLUSIONS The lower initial hospital costs of the noninvasive approach are offset by greater follow-up costs . Within two years the costs of the two approaches are equivalent . Thus , greater antiarrhythmic efficacy can be achieved by the invasive approach to drug selection without increasing total hospital costs .
23646
Intervention_Physical
noninvasive
23647
Intervention_Educational
and
23648
Intervention_Surgical
invasive
23649
Intervention_Educational
approaches .
23650
Intervention_Physical
noninvasive
23651
Intervention_Surgical
invasive
23652
Intervention_Physical
noninvasive
23653
Intervention_Physical
invasive
23654
Intervention_Surgical
invasive approach
23655
Intervention_Physical
noninvasive approach
23656
Intervention_Physical
noninvasive
23657
Intervention_Surgical
invasive
23658
Intervention_Surgical
invasive approach
23659
Outcome_Other
Economic evaluation
23660
Outcome_Other
Costs of initial and follow-up
23661
Outcome_Other
economic evaluation
23662
Outcome_Physical
sustained ventricular tachyarrhythmia recurrence
23663
Outcome_Physical
including sudden death
23664
Outcome_Other
Initial hospitalization
23665
Outcome_Other
costly
23666
Outcome_Other
follow-up hospital costs
23667
Outcome_Other
total hospital costs
23668
Outcome_Physical
symptomatic ventricular tachyarrhythmia
23669
Outcome_Other
initial hospital costs
23670
Outcome_Other
costs
23671
Outcome_Physical
antiarrhythmic efficacy
23672
Outcome_Other
total hospital costs
23673
Participant_Condition
ventricular tachycardia
23674
Participant_Sample-size
124
23675
Participant_Sample-size
57