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How to truly value implantable cardioverter-defibrillators technology: Up-front cost or daily cost?

Published online by Cambridge University Press:  27 June 2011

Mauro Biffi ,
Matteo Ziacchi ,
Matteo Bertini ,
Beatrice Gardini ,
Andrea Mazzotti ,
Giulia Massaro ,
Cristian Martignani ,
Igor Diemberger ,
Giuseppe Boriani  and
Daniela Corsini
Mauro Biffi
Affiliation:
University of Bologna
Matteo Ziacchi
Affiliation:
University of Bologna
Matteo Bertini
Affiliation:
University of Bologna
Beatrice Gardini
Affiliation:
University of Bologna
Andrea Mazzotti
Affiliation:
University of Bologna
Giulia Massaro
Affiliation:
University of Bologna
Cristian Martignani
Affiliation:
University of Bologna
Igor Diemberger
Affiliation:
University of Bologna
Giuseppe Boriani
Affiliation:
University of Bologna
Daniela Corsini
Affiliation:
Policlinico S. Orsola-Malpighi
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Abstract

Background: We calculated the daily cost of implantable cardioverter-defibrillators (ICDs) based on their actual longevity to prove whether the up-front cost is a reliable parameter for the ICD purchasing-process.

Methods. Longevity of single chamber (SC), double chamber (DC), and biventricular (BiV) ICDs from Medtronic (MDT), Guidant (GDT), and St. Jude Medical (SJM) was measured in all the patients implanted in years 2000, 2001, 2002 who reached device replacement within December 31, 2009. The cost of each ICD (device + lead/s) was normalized for its own longevity. Data are expressed as median (25th–75th percentile).

Results: A total of 123/153 patients completed the study, 70 percent being alive 8 years after implantation. MDT devices had a superior longevity compared with GDT and SJM (p < .001). Fifty-eight percent of replaced ICDs had a service life at least 1 year shorter than the manufacturers' prediction. Longer-lasting devices had a significantly lower daily cost: €4.8 (4.6–5.7) versus €6.8 (6.2–9.2) and €6.9 (6.2–7.6) for SC (p < .001); €6.9 (6.8–7.7) versus €12.6 (11.8–13.3) and €13.4 (10.3–16.1) for DC; €8.5 (8.3–10.3) versus €15.4 (15.1–15.8) and €14.6 (14.1–14.9) for BiV (p < .005).

Conclusions: The true cost of ICD treatment is strictly dependent on device longevity, whereas device up-front cost is unreliable. This aspect should be valued in the technology purchasing process, and could set the basis for an outcome-based reimbursement system. Our observations may be the benchmark respectively for ICD longevity and daily ICD cost in future comparisons. Independent observations in the real-life scenario are needed to properly value newer technologic improvements.

Keywords

ICD longevityICD costICD replacement
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 27 , Issue 3 , July 2011 , pp. 201 - 206
Copyright
Copyright © Cambridge University Press 2011

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References

REFERENCES

1. Al-Khatib, SM, Anstrom, KJ, Eisenstein, EL, et al. Clinical and economic implications of the Multicenter Automatic Defibrillator Implantation Trial-II. Ann Intern Med. 2005;142:593–600.CrossRefGoogle ScholarPubMed
2. Bardy, G, Lee, KL, Mark, DB, et al. for the SCD-HeFT Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352:225–237.CrossRefGoogle ScholarPubMed
3. Biffi, M, Ziacchi, M, Bertini, M, et al. Longevity of implantable cardioverter-defibrillators: Implications for clinical practice and health care systems. Europace. 2008;10:1288–1295.CrossRefGoogle ScholarPubMed
4. Boriani, G, Diemberger, I, Martignani, C, et al. Telecardiology and remote monitoring of implanted electrical devices: The potential for fresh clinical care perspectives. J Gen Intern Med. 2008;23 (Suppl 1):73–77.CrossRefGoogle ScholarPubMed
5. Burri, H, Senouf, D. Remote monitoring and follow-up of pacemakers and implantable cardioverter defibrillators. Europace. 2009;11:701–709.CrossRefGoogle ScholarPubMed
6. Buxton, AE, Lee, KL, Fisher, JD, et al. A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators. N Engl J Med. 1999;341:1882–1890.CrossRefGoogle ScholarPubMed
7. Camm, J, Klein, H, Nisam, S. The cost of implantable defibrillators: Perceptions and reality. Eur Heart J. 2007:28;392–397.CrossRefGoogle Scholar
8. Cygankiewicz, I, Gillespie, J, Zareba, W, et al. for the MADIT II Investigators Predictors of long-term mortality in Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) patients with implantable cardioverter-defibrillators. Predictors of long-term mortality in Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) patients with implantable cardioverter-defibrillators. Heart Rhythm. 2009;6:468–473.CrossRefGoogle ScholarPubMed
9. Drummond, MF, Schwartz, JS, Jönsson, B, et al. Key principles for the improved conduct of health technology assessments for resource allocation decisions. Int J Technol Assess Health Care. 2008;24:244–258.CrossRefGoogle ScholarPubMed
10. Gould, PA, Krahn, AD. Complications associated with implantable cardioverter-defibrillator replacement in response to device advisories. JAMA. 2006;295:1907–1911.CrossRefGoogle ScholarPubMed
11. Hauser, RG. The growing mismatch between patient longevity and the service life of implantable cardioverter-defibrillators. J Am Coll Cardiol. 2005;45:2022–2025.CrossRefGoogle ScholarPubMed
12. Hauser, RG, Hayes, DL, Epstein, AE, et al. Multicenter experience with failed and recalled implantable cardioverter-defibrillator pulse generators. Heart Rhythm. 2006;3:640–644.CrossRefGoogle ScholarPubMed
13. Klug, D, Balde, M, Pavin, D, et al. Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators: Results of a large prospective study. Circulation. 2007;116:1349–1355.CrossRefGoogle ScholarPubMed
14. Klug, D, Vaksmann, G, Jarwe, M, et al. Pacemaker lead infection in young patients. Pacing Clin Electrophysiol. 2003;26:1489–1493.CrossRefGoogle ScholarPubMed
15. Knops, P, Theuns, DA, Res, JC, Jordaens, L. Analysis of implantable defibrillator longevity under clinical circumstances: Implications for device selection. Pacing Clin Electrophysiol. 2009;32:1276–1285.CrossRefGoogle ScholarPubMed
16. Mark, DB, Nelson, CL, Anstrom, KJ, et al. for the SCD-HeFT Investigators. Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure. Results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). Circulation. 2006;114:135–142.CrossRefGoogle ScholarPubMed
17. Moss, AJ, Hall, WJ, Cannom, DS, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med. 1996;335:1933–1940.CrossRefGoogle ScholarPubMed
18. Moss, AJ, Zareba, W, Hall, WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877–883.CrossRefGoogle ScholarPubMed
19. Porter, ME, Olmsted Teisberg, E. Redefining health care: Creating value-based competition on results. Boston: Harvard Business School Press; 2006.Google Scholar
20. Ramachandra, I. Impact of ICD battery longevity on need for device replacements-insights from a veterans affairs database. Pacing Clin Electrophysiol. 2010;33:314–319.CrossRefGoogle ScholarPubMed
21. Sanders, GD, Hlatky, MA, Owens, DK. Cost-effectiveness of implantable cardioverter-defibrillators. N Engl J Med. 2005;353:1471–1480.CrossRefGoogle ScholarPubMed
22. Schaer, BA, Koller, MT, Sticherling, C, et al. Longevity of implantable cardioverter-defibrillators, influencing factors, and comparison to industry-projected longevity. Heart Rhythm. 2009;6:1737–1743.CrossRefGoogle ScholarPubMed
23. The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med. 1997;337:1576–1583.CrossRefGoogle Scholar
24. Wild, DM, Fisher, JD, Kim, SG, et al. Pacemakers and implantable cardioverter defibrillators: Device longevity is more important than smaller size: The patient's viewpoint. Pacing Clin Electrophysiol. 2004;27:1526–1529.CrossRefGoogle ScholarPubMed