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

Abstract

AimsTo 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 resultsWe 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 E10 926.91, E728.46, and E1.99 for Population A, and E7661.32, E510.75, and E1.40 for Population B. Total, yearly, and per diem savings from extending CRT-D longevity to 7 years were E13 630.38, E908.69, and E2.49 for Population C, and E10 968.29, E731.22, and E2.00 for Population D. Avoidance of a generator replacement amounted up to 46.6-62.5% of the saving. ConclusionExtending 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.--

Subcutaneous vs intravenous administration of immunoglobulin in chronic inflammatory demyelinating polyneuropathy: an Italian cost-minimization analysis

“…An appropriate statistical distribution was given to each parameter and a reasonable coefficient of variation was applied to their base case estimate to obtain the standard error (SE) [30][31][32]. The SE for proportions was calculated assuming a sample of 100 patients (Table 3).…”

The mismatch between patient life expectancy and the service life of implantable devices in current cardioverter-defibrillator therapy: a call for larger device batteries

“…This has of course an impact on costeffectiveness assessment. However, the studies by Biffi [21] and Boriani [22] nicely demonstrate the strong effects of device longevity on therapy costs. Depending on device longevity the daily costs of defibrillator therapy varied in the range of 6.9 € to 13.4 €, and in the range of 8.5 € to 15.4 € in CRT-D therapy [21].…”

“…Depending on device longevity the daily costs of defibrillator therapy varied in the range of 6.9 € to 13.4 €, and in the range of 8.5 € to 15.4 € in CRT-D therapy [21]. Boriani and coworkers [22] demonstrated the potential effects on long-term costs of defibrillator therapy by prolonging device service life from 5 to 9 years for ICD and from 4 to 7 years for CRT devices. Total cost savings for a prolonged ICD service life were 7,661 € to 10,926 € for ICD devices, and 10,968 € to 13,630 € for CRT-D devices.…”

Cardiolaminopathies from bench to bedside: challenges in clinical decision-making with focus on arrhythmia-related outcomes

“…An important innovation is the extension of device longevity to up to 10 years. through improvement of device batteries [68,69] This makes it possible to reduce the number of device replacements with benefits related to reduced risk of infections and reduced long-term costs [69]. …”