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Implications of the Multicenter Automatic Defibrillator Implantation Trial-II
- Sana M. Al-Khatib, MD, MHS;
- Daniel B. Mark, MD; and
- Robert M. Califf, MD
- From Duke University Clinical Research Institute, Durham, NC 27710.
IN RESPONSE:
Dr. Weintraub argues that eplerenone, an aldosterone blocker, is more cost-effective than the ICD. Although his estimated incremental cost-effectiveness ratio of $10 402 per life-year gained for eplerenone seems much more favorable than our base-case ratio of $50 500 per life-year gained for an ICD, we caution against these comparisons when the interventions are not compared head-to-head. Both MADIT-II and EPHESUS enrolled appreciably different patients. Whereas all patients in EPHESUS had clinical or radiographic evidence of heart failure, half of the patients in MADIT-II did not. All patients in …
