Sudden cardiac death (SCD) is a devastating complication of hypertrophic cardiomyopathy (HCM).  The optimal strategy for the primary prevention of SCD in HCM remains controversial.

Using a Markov model, the investigators compared the health benefits and cost-effectiveness of three strategies for the primary prevention of SCD: implantable cardioverter/defibrillator (ICD) insertion, amiodarone therapy, or no therapy.  They modeled hypothetical cohorts of 45-year-old patients with HCM with no history of cardiac arrest but at significant risk of SCD (3%/y).

Over a lifetime, compared with no therapy, ICD therapy increased quality-adjusted survival by 4.7 quality-adjusted life years (QALYs) at an additional cost of $142,800 ($30,000 per QALY), whereas amiodarone increased quality-adjusted survival by 2.8 QALYs at an additional cost of $104,900 ($37,300 per QALY).  Compared with no therapy, ICD therapy would cost < $50,000 per QALY for patients (i) aged 25, with > or = 1 risk factors for SCD, and (ii) aged 45 or 65, with > or = 2 risk factors for SCD.

An ICD strategy is projected to yield the greatest increase in quality-adjusted life expectancy of the three treatment strategies evaluated.  Combined consideration of age and the number of risk factors for SCD may allow more precise tailoring of ICD therapy to its expected benefits.