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

By Gialama, Fotini; Prezerakos, Panagiotis et al. | Applied Health Economics and Health Policy, February 2014 | Go to article overview

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


Gialama, Fotini, Prezerakos, Panagiotis, Maniadakis, Nikos, Applied Health Economics and Health Policy


Published online: 16 November 2013

© Springer International Publishing Switzerland 2013

Abstract

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]. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

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

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.