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

BACKGROUND: While children at high risk of sudden cardiac death (SCD) (>6% over 5 years) receive implanted cardioverter defibrillators (ICDs), there are no guidelines for those at lower risk. For children at intermediate risk of SCD (4-6% over 5 years), the utility and cost effectiveness of in-home automated external defibrillators (AED) are unclear. OBJECTIVE: To assess the cost effectiveness of in-home AED for children at intermediate risk of SCD. METHODS: Utilizing hypertrophic cardiomyopathy (HCM) as the proxy disease, a theoretical cohort of 1,550 ten-year old children with HCM was followed for 69 years. Baseline annual risk of SCD was 0.8%. Outcomes were sudden cardiac death (SCD), severe neurological 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. RESULTS: Among children at intermediate risk of 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, below the willingness-to-pay threshold. CONCLUSIONS: For children at intermediate risk of 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 utilization in this population.