Impact of extending device longevity on the long-term costs of implantable cardioverter-defibrillator therapy: a modelling study with a 15-year time horizon

Europace. 2013 Oct;15(10):1453-62. doi: 10.1093/europace/eut133. Epub 2013 May 21.

Abstract

Aims: To determine the long-term costs of extending device longevity in four patient populations requiring a single-chamber implantable cardioverter-defibrillator (ICD) or requiring cardiac resynchronization therapy with defibrillation (CRT-D) device over a 15-year time window.

Methods and results: We considered patient populations with an accepted indication for a single-chamber ICD for prevention of sudden cardiac death in the context of preserved (Population A) or impaired (Population B) left ventricular function; or with indication for a CRT-D device in the context of heart failure in New York Heart Association class II (Population C) or III (Population D). Expected patient survival and a cost analysis, including the cost of complications, was undertaken from a hospital perspective. Extended device longevity of 5 vs. 9 years for ICDs (Populations A and B); 4 vs. 7 years for CRT-Ds (Populations C and D) were considered. Over a 15-year time horizon, total, yearly, and per diem savings, per patient, from extending ICD longevity to 9 years were €10 926.91, €728.46, and €1.99 for Population A, and €7661.32, €510.75, and €1.40 for Population B. Total, yearly, and per diem savings from extending CRT-D longevity to 7 years were €13 630.38, €908.69, and €2.49 for Population C, and €10 968.29, €731.22, and €2.00 for Population D. Avoidance of a generator replacement amounted up to 46.6-62.5% of the saving.

Conclusion: Extending device longevity has an important effect on the long-term cost of device therapy, both for ICD and CRT-D. This has important implications for device choice.

Keywords: Budget; Cardiac resynchronization therapy; Cost; Cost analysis; Device longevity; Economics; Implantable cardioverter-defibrillator; Primary prevention; Sudden death.

MeSH terms

  • Arrhythmias, Cardiac / complications
  • Arrhythmias, Cardiac / diagnosis
  • Arrhythmias, Cardiac / physiopathology
  • Arrhythmias, Cardiac / therapy*
  • Budgets
  • Cardiac Resynchronization Therapy / economics*
  • Cardiac Resynchronization Therapy Devices / economics*
  • Cost Savings
  • Cost-Benefit Analysis
  • Death, Sudden, Cardiac / etiology
  • Death, Sudden, Cardiac / prevention & control*
  • Defibrillators, Implantable / economics*
  • Electric Countershock / economics*
  • Electric Countershock / instrumentation
  • Equipment Design
  • Equipment Failure / economics
  • Health Care Costs*
  • Heart Failure / complications
  • Heart Failure / diagnosis
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Humans
  • Models, Economic
  • Primary Prevention / economics*
  • Primary Prevention / instrumentation
  • Prosthesis Design
  • Prosthesis Failure
  • Time Factors
  • Treatment Outcome
  • Ventricular Function, Left