Defibrillators in Heart Failure and Quality of Life

To the Editor: Mark et al. (Sept. 4 issue) 1 report data on quality of life from the well-designed Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). These data call for a repeat cost-effectiveness analysis of the use of implantable cardioverter–defibrillators (ICDs) for the primary prevention of death from cardiac causes. The newly reported utilities were 0.80 at baseline and 0.70 at 30 months. Mark et al. did not report these utilities in their previous cost-effectiveness analysis. 2 In contrast, a separate cost-effectiveness analysis assumed a utility of 0.88 and showed ICDs to be cost-effective. 3 The application of these new utilities to . . .