The cost-effectiveness of primary prophylactic implantable defibrillator therapy in patients with ischaemic or non-ischaemic heart disease: a European analysis

Smith, Timothy W.; Jordaens, Luc; Theuns, Dominic; Dessel, Pascal F. van; Wilde, Arthur A.M.; Hunink, M. G. Myriam

doi:10.1093/eurheartj/ehs090

Cited by 63 publications

(35 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore it seems reasonable to assume that the incremental cost effectiveness ratio of our network organisation is well below the often cited willingness-to-pay threshold of €80.000/QALY; and also below the estimated incremental cost effectiveness ratio of approximately €44.000 Euro/QALY of primary prophylactic ICD therapy in patients with a left ventricular ejection fraction < 40% [28]. …”

Section: Discussionmentioning

confidence: 99%

Short term cost effectiveness of a regional myocardial infarction network

Birkemeyer

Dauch

Müller³

et al. 2013

Health Econ Rev

View full text Add to dashboard Cite

AimsMyocardial infarction networks have been shown to improve guideline adherent therapy and outcomes in patients presenting with acute ST-elevation myocardial infarction (STEMI). Our objective was to assess the short term cost effectiveness of a network structure.Methods and resultsOutcome data and reimbursement data for the index hospital stay were gathered in consecutive patients with acute STEMI (n = 536) admitted to any of the hospitals in a 350.000 inhabitant rural network area during the years 2002 (n = 185), 2005 (n = 163) and 2008 (n = 188). Network structure was established between 2002 and 2005 aiming for identical treatment of all acute STEMI patients during 24 h/7d a week with primary angioplasty. Patient baseline characteristics in the different years were quite comparable. From 2002 to 2005 regional hospital mortality in STEMI patients decreased from 16% to 9%. Lower mortality under network conditions was confirmed in 2008. Reimbursement data of different years were standardized to exclude effects not induced by the network. The mean initial costs per saved live during the index stay were €7727 with a 95%-confidence interval of €-3.500 to €36.700 (referenced to the German reimbursement in 2005).ConclusionThe short term cost effectiveness of a myocardial infarction network organisation is within well accepted boundaries under conditions of the German reimbursement system.

show abstract

Section: Discussionmentioning

confidence: 99%

Short term cost effectiveness of a regional myocardial infarction network

Birkemeyer

Dauch

Müller³

et al. 2013

Health Econ Rev

View full text Add to dashboard Cite

show abstract

“…W późniejszych próbach klinicznych wykazano korzyści z leczenia za pomocą defibrylatorów u pacjentów zagrożo-nych wystąpieniem nagłego zgonu. Leczenie za pomocą ICD zapobiega nagłym zgonom i wydłuża życie pacjentom z grupy wysokiego ryzyka nagłego zgonu arytmicznego, o ile u pacjenta nie występują inne stany ograniczające oczekiwaną długość dalszego życia do < 1-2 lat [146]. W długoterminowych badaniach wykazano skuteczność ICD [147] oraz urządzeń do terapii resynchronizującej (CRT) działających również jako defibrylatory (CRT-D) [148] w trakcie obserwacji trwającej średnio odpowiednio 8 oraz 7 lat.…”

Section: Implantowany Kardiowerter-defibrylatorunclassified

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

Priori

Blomström‐Lundqvist²,

Mazzanti³

et al. 2015

Kardiol Pol

233

337

View full text Add to dashboard Cite

“…A shift in indication from predominantly secondary to primary prophylaxis occurred due to a significantly higher number of suitable candidates, which increased further with the broadening of indications in the guidelines of 2008 [9]. However, recent reports express concerns about cost-effectiveness and the benefit-complication ratio [12–15]. The question is in which patients and in how many of them we actually prevent a sudden cardiac death.…”

Section: Introductionmentioning

confidence: 99%

Implementation of guidelines for implantable cardioverter-defibrillator therapy in clinical practice: Which patients do benefit?

et al. 2013

View full text Add to dashboard Cite

PurposeBased on multiple large clinical trials conducted over the last decades guidelines for implantable cardioverter-defibrillator (ICD) implantations have been evolving. The increase in primary prophylactic ICD implantations challenges us to be critical towards the indications in certain patient populations.MethodsWe retrospectively collected patient characteristics and rates of appropriate and inappropriate ICD therapy, appropriate and inappropriate ICD shock and mortality of all patients who received an ICD in the University Medical Center Utrecht (UMCU) over the years 2006–2011.ResultsA total of 1075 patients were included in this analysis (74 % male, mean age 61 ± 13 years, left ventricular ejection fraction 30 ± 13 %); 61 % had a primary indication and 58 % had ischaemic heart disease. During a mean follow-up period of 31 ± 17 months, 227 of the patients (21 %) received appropriate ICD therapy (149 (14 %) patients received an appropriate ICD shock). Females, patients with a primary prophylactic indication and patients with non-ischaemic heart disease experienced significantly less ICD therapy. Only a few patients (54, 5 %) received inappropriate ICD therapy; 33 (3 %) patients received an inappropriate ICD shock. Fifty-five patients died within one year after ICD implantation and were therefore, in retrospect, not eligible for ICD implantation.ConclusionOur study confirms the benefit of ICD implantation in clinical practice. Nevertheless, certain patients experience less benefit than others. A more patient-tailored risk stratification based on electrophysiological parameters would be lucrative to improve clinical benefit and cost-effectiveness.

show abstract

The cost-effectiveness of primary prophylactic implantable defibrillator therapy in patients with ischaemic or non-ischaemic heart disease: a European analysis

Abstract: Our results suggest that primary prophylactic ICD therapy in patients with a left ventricular ejection fraction <40% and ischaemic or non-ischaemic heart disease is cost-effective in the European setting.

Cited by 63 publications

References 33 publications

Short term cost effectiveness of a regional myocardial infarction network

Short term cost effectiveness of a regional myocardial infarction network

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

Implementation of guidelines for implantable cardioverter-defibrillator therapy in clinical practice: Which patients do benefit?

Contact Info

Product

Resources

About