Academic journal article Applied Health Economics and Health Policy

The Cost Effectiveness of Implantable Cardioverter Defibrillators: A Systematic Review of Economic Evaluations

Academic journal article Applied Health Economics and Health Policy

The Cost Effectiveness of Implantable Cardioverter Defibrillators: A Systematic Review of Economic Evaluations

Article excerpt

Published online: 16 November 2013

© Springer International Publishing Switzerland 2013


Background Sudden cardiac death (SCD) is the most common cause of death in developed countries, with more than 3 million people dying yearly. Implantable cardioverter defibrillators (ICDs) are considered to be an effective treatment in the primary and secondary prevention of SCD; however, their cost is considerable and this poses questions regarding whether they are worth the investment relative to less expensive pharmacotherapy.

Objective The aim of this systematic review is to investigate existing evidence regarding the cost effectiveness of ICD therapy and to identify the key drivers of cost effectiveness, for the purpose of informing interested policy and decision makers.

Methodology A systematic review of the literature concerning the cost effectiveness of ICDs was undertaken. Electronic databases, including PubMed, Cochrane and Health Economic Evaluations Database were searched based on appropriate terms and their combinations. Economic evaluation studies that examined the cost effectiveness of ICDs were selected and 34 were included for evaluation.

Results Findings from the present analysis show that ICD therapy, in properly selected patients who are at high risk of sudden cardiac death, is associated with similar or better cost-effectiveness ratios compared with other well accepted conventional treatments. The cost effectiveness of ICDs is influenced by several factors, including ICD efficacy and safety, impact on patient quality of life, device original implantation cost, frequency and cost of battery replacement, patient demographics and risk profile and analysis time horizon.

Conclusion ICDs may represent a cost-effective option relative to pharmacotherapy in appropriately selected patient groups. The cost-effectiveness ratios appear to be at acceptable and comparable levels to other established treatments in cardiovascular and non-cardiovascular diseases. However, cost effectiveness is highly related to several factors and hence economic efficiency is highly dependent on conditions that need to be fulfilled for each individual case in medical practice. The aforementioned factors and technological advances imply that to ensure cost-effective use of ICD therapy, continuous research is needed.

1 Introduction

Sudden cardiac death (SCD) is a sudden death caused by loss of heart function [sudden cardiac arrest (SCA)], occurring unexpectedly within a short period from the onset of symptoms. It occurs most frequently in adults in their thirties and forties and affects men twice as often as it does women [1]. It represents a major cause of mortality in the developed world and it is estimated that over 3 million people die from it annually [2]. The degree of the problem can be revealed by the fact that the yearly number of SCDs is greater than the number of deaths from AIDS, breast cancer, lung cancer and stroke together [2, 3]. Most SCDs are caused by arrhythmias, with the most common life-threatening arrhythmia being ventricular fibrillation (VF), which is an erratic, disorganized firing of impulses from the heart ventricles [3]. When this occurs, the heart is unable to pump blood and death may occur within minutes, if leftuntreated.

There are many factors that can increase a person's risk of SCA and SCD. These include previous myocardial infarction (MI); coronary artery disease (CAD); leftventricular ejection fraction (LVEF) of less than 40 % combined with ventricular tachycardia (VT); prior episode of SCA; family history of SCA or SCD; personal or family history of certain abnormal heart rhythms such as long QT syndrome (LQTS); Wolff-Parkinson-White syndrome; extremely low heart rates or heart block; VT or ventricular fibrillation (VF) after an MI; blood vessel abnormalities; history of syncope (fainting episodes of unknown cause); heart failure (HF); dilated cardiomyopathy (DCM); hypertrophic cardiomyopathy (HCM); significant changes in blood levels of potassium and magnesium (from using certain drugs); obesity; diabetes mellitus; recreational drug abuse; genetic factors; and molecular and other structural heart defects [1]. …

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