The marginal cost-effectiveness ratio of amiodarone is lower ($68, 519/QALY gained) than that for an ICD calculated in the previous example, and furthermore, because the effectiveness of an ICD is now compared to amiodarone rather than to no therapy, the addition of this intermediate cost strategy with partial effectiveness increases the ICD's marginal cost-effectiveness ratio from $118, 000 to $192, 222/QALY gained.