Primary prevention of sudden cardiac death: can we afford the cost of cardioverter-defibrillators? Data from the Search-MI Registry-Italian sub-study.

Abstract

BACKGROUND:

Large randomized trials show that in appropriately selected patients with left ventricular dysfunction, implantable cardioverter-defibrillators (ICDs) can improve overall survival at 2-5 years. Since direct implementation of the criteria used in the MADIT II and SCD-HeFT will lead to a marked rise in ICD implants, there is a growing fear that increased use of ICDs may cause a dramatic burden to health care systems. The ICD has traditionally been seen as an expensive form of treatment, which is difficult to accept at the first look. This is mainly due to the nonlinear character of the ICD investment, characterized by high initial expenditure, followed by a deferred pay-off in terms of clinical benefits. Cost-effectiveness analysis may help provide a different perspective on the problem of ICD cost, as may estimation of the daily cost of ICD treatment, assuming a time horizon of 5-7 years--a particularly interesting subject for further registry studies.

METHODS AND RESULTS:

Based on real expenditure data from 2002 to 2005, as recorded in the Search-MI Registry-Italian Sub-study of patients implanted on MADIT II indications, we estimated the daily costs associated with the device and leads. Over a 5-7 year time horizon, the average daily cost was estimated to be euro 4.60-euro 6.70. Translation of these figures into U.S. market conditions suggests a daily cost of around $7.90-$11.40.

CONCLUSIONS:

These findings appear useful to help evaluate the affordability of ICD in comparison with other therapeutic options in a context of limited available economic resources.

• Authors: Giuseppe Boriani, Mauro Biffi, Maurizio Russo, Maurizio Lunati, Gianluca Botto, Alessandro Proclemer, Giuseppe Vergara, Werner Rahue, Cristian Martignani, Renato Ricci, Massimo Santini, SEARCH MI Registry Italian Investigators
• Journal: Pacing and clinical electrophysiology : PACE (Pacing Clin Electrophysiol) Vol. 29 Suppl 2 Pg. S29-34 (Dec 2006) ISSN: 0147-8389 [Print] United States
• PMID: 17169130 (Publication Type: Journal Article)

Topics

• Aged
• Cost-Benefit Analysis
• Death, Sudden, Cardiac (epidemiology, prevention & control)
• Electric Countershock (economics, statistics & numerical data)
• Female
• Health Care Costs (statistics & numerical data)
• Humans
• Italy (epidemiology)
• Male
• Primary Prevention (economics, statistics & numerical data)
• Registries (statistics & numerical data)