Skip to main content
Top
Published in: Current Heart Failure Reports 3/2024

25-04-2024 | Heart Failure | Review

Economic Considerations of Cardiovascular Implantable Electronic Devices for The Treatment of Heart Failure

Authors: Christian Elsner, Simon Bettin, Roland Tilz, Dennis Häckl

Published in: Current Heart Failure Reports | Issue 3/2024

Login to get access

Abstract

Purpose of Review

Heart failure (HF) is a major public health problem worldwide, affecting more than 64 million people [1]. The complex and severe nature of HF presents challenges in providing cost-effective care as patients often require multiple hospitalizations and treatments. This review of relevant studies with focus on the last 10 years summarizes the health and economic implications of various HF treatment options in Europe and beyond. Although the main cost drivers in HF treatment are clinical (re)admission and decompensation of HF, an assessment of the economic impacts of various other device therapy options for HF care are included in this review. This includes: cardiovascular implantable electronic devices (CIEDs) such as cardiac-resynchronisation-therapy devices that include pacemaking (CRT-P), cardiac-resynchronisation-therapy devices that include defibrillation (CRT-D), implantable cardioverter/defibrillators (ICDs) and various types of pacemakers. The impact of (semi)automated (tele)monitoring as a relevant factor for increasing both the quality and economic impact of care is also taken into consideration. Quality of life adjusted life years (QALYs) are used in the overall context as a composite metric reflecting quantity and quality of life as a standardized measurement of incremental cost-effectiveness ratios (ICER) of different device-based HF interventions.

Recent Findings

In terms of the total cost of different devices, CRT-Ds were found in several studies to be more expensive than all other devices in regards to runtime and maintenance costs including (re)implantation. In the case of CRT combined with an implantable cardioverter-defibrillator (CRT-D) versus ICD alone, CRT-D was found to be the most cost-effective treatment in research work over the past 10 years. Further comparison between CRT-D vs. CRT-P does not show an economic advantage of CRT-D as a minority of patients require shock therapy. Furthermore, a positive health economic effect and higher survival rate is seen in CRT-P full ventricular stimulation vs. right heart only stimulation. Telemedical care has been found to provide a positive health economic impact for selected patient groups—even reducing patient mortality. For heart failure both in ICD and CRT-D subgroups the given telemonitoring benefit seems to be greater in higher-risk populations with a worse HF prognosis.

Summary

In patients with HF, all CIED therapies are in the range of commonly accepted cost-effectiveness. QALY and ICER calculations provide a more nuanced understanding of the economic impact these therapies create in the healthcare landscape. For severe cases of HF, CRT-D with telemedical care seems to be the better option from a health economic standpoint, as therapy is more expensive, but costs per QALY range below the commonly accepted threshold.
Literature
1.
go back to reference GBD. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2017;392:1789–858. GBD. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2017;392:1789–858.
2.
go back to reference Hobbs FD, Roalfe AK, Davis RC, Davies MK, Hare R. the Midlands Research Practices Consortium (MidReC). Prognosis of all-cause heart failure and borderline left ventricu- lar systolic dysfunction: 5 year mortality follow-up of the Echocardiographic Heart of England Screening Study (ECHOES). Eur Heart J. 2007;28:1128–34.CrossRefPubMed Hobbs FD, Roalfe AK, Davis RC, Davies MK, Hare R. the Midlands Research Practices Consortium (MidReC). Prognosis of all-cause heart failure and borderline left ventricu- lar systolic dysfunction: 5 year mortality follow-up of the Echocardiographic Heart of England Screening Study (ECHOES). Eur Heart J. 2007;28:1128–34.CrossRefPubMed
3.
go back to reference Cook C, Cole G, Asaria P, Jabbour R, Francis DP. The annual global economic burden of heart failure. Int J Cardiol. 2014;171:368–76.CrossRefPubMed Cook C, Cole G, Asaria P, Jabbour R, Francis DP. The annual global economic burden of heart failure. Int J Cardiol. 2014;171:368–76.CrossRefPubMed
4.
go back to reference Nichols GA, Reynolds K, Kimes TM, Rosales AG, Chan WW. Comparison of risk of re- hospitalization, all-cause mortality, and medical care resource utilization in patients with heart failure and preserved versus reduced ejection fraction. Am J Cardiol. 2015;116:1088–92.CrossRefPubMed Nichols GA, Reynolds K, Kimes TM, Rosales AG, Chan WW. Comparison of risk of re- hospitalization, all-cause mortality, and medical care resource utilization in patients with heart failure and preserved versus reduced ejection fraction. Am J Cardiol. 2015;116:1088–92.CrossRefPubMed
5.
go back to reference Maggioni AP, Dahlström U, Filippatos G, Chioncel O, Leiro MC, Drozdz J, ... Heart Failure Association of the ESC (HFA) (2010) EURObservational research programme: the heart failure pilot survey (ESC‐HF Pilot). Europe J Heart Fail 12(10):1076–1084 Maggioni AP, Dahlström U, Filippatos G, Chioncel O, Leiro MC, Drozdz J, ... Heart Failure Association of the ESC (HFA) (2010) EURObservational research programme: the heart failure pilot survey (ESC‐HF Pilot). Europe J Heart Fail 12(10):1076–1084
8.
go back to reference Ponikowski P, Voors AA, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200. https://doi.org/10.1093/eurheartj/ehw128.CrossRefPubMed Ponikowski P, Voors AA, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200. https://​doi.​org/​10.​1093/​eurheartj/​ehw128.CrossRefPubMed
12.
go back to reference McMurray JJV, Adamopoulos S, Anker SD, et al. Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787–847. https://doi.org/10.1093/eurheartj/ehs104.CrossRefPubMed McMurray JJV, Adamopoulos S, Anker SD, et al. Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787–847. https://​doi.​org/​10.​1093/​eurheartj/​ehs104.CrossRefPubMed
15.
go back to reference Lindmark K, Boman K, Olofsson M, Törnblom M, Levine A, Castelo-Branco A, Schlienger R, Bruce Wirta S, Stålhammar J, Wikström G. Epidemiology of heart failure and trends in diagnostic work-up: a retrospective, population-based cohort study in Sweden. Clin Epidemiol. 2019;11:231–44.CrossRefPubMedPubMedCentral Lindmark K, Boman K, Olofsson M, Törnblom M, Levine A, Castelo-Branco A, Schlienger R, Bruce Wirta S, Stålhammar J, Wikström G. Epidemiology of heart failure and trends in diagnostic work-up: a retrospective, population-based cohort study in Sweden. Clin Epidemiol. 2019;11:231–44.CrossRefPubMedPubMedCentral
16.
go back to reference Al-Omary MS, Davies AJ, Evans TJ, Bastian B, Fletcher PJ, Attia J, Boyle AJ. Mortality and readmission following hospitalisation for heart failure in Australia: a systematic review and meta-analysis. Heart Lung Circ. 2018;27:917–27.CrossRefPubMed Al-Omary MS, Davies AJ, Evans TJ, Bastian B, Fletcher PJ, Attia J, Boyle AJ. Mortality and readmission following hospitalisation for heart failure in Australia: a systematic review and meta-analysis. Heart Lung Circ. 2018;27:917–27.CrossRefPubMed
18.
go back to reference Barra S, Providencia R, Narayanan K, Boveda S, Duehmke R, Garcia R, Leyva F, Roger V, Jouven X, Agarwal S, Levy WC, Marijon E. Time trends in sudden cardiac death risk in heart failure patients with cardiac resynchronization therapy: a systematic review. Eur Heart J. 2020;41:1976–86.CrossRefPubMed Barra S, Providencia R, Narayanan K, Boveda S, Duehmke R, Garcia R, Leyva F, Roger V, Jouven X, Agarwal S, Levy WC, Marijon E. Time trends in sudden cardiac death risk in heart failure patients with cardiac resynchronization therapy: a systematic review. Eur Heart J. 2020;41:1976–86.CrossRefPubMed
21.
go back to reference Banka G, Heidenreich PA, Fonarow GC. Incremental cost-effectiveness of guideline-directed medical therapies for heart failure. J Am Coll Cardiol. 2013;61(32):1440.CrossRefPubMed Banka G, Heidenreich PA, Fonarow GC. Incremental cost-effectiveness of guideline-directed medical therapies for heart failure. J Am Coll Cardiol. 2013;61(32):1440.CrossRefPubMed
22.
go back to reference Joseph P, Dokainish H, McCready T, Budaj A, Roy A, Ertl G, Gomez-Mesa JE, Leong D, Ezekowitz J, Hage C, Lanas F, Maggioni AP, Sliwa K, Zhu J, Rouleau J, Balasubramanian K, Yusuf S, Investigators GC. A multinational registry to study the characteristics and outcomes of heart failure patients: the global congestive heart failure (G-CHF) registry. Am Heart J. 2020;227:56–63.CrossRefPubMed Joseph P, Dokainish H, McCready T, Budaj A, Roy A, Ertl G, Gomez-Mesa JE, Leong D, Ezekowitz J, Hage C, Lanas F, Maggioni AP, Sliwa K, Zhu J, Rouleau J, Balasubramanian K, Yusuf S, Investigators GC. A multinational registry to study the characteristics and outcomes of heart failure patients: the global congestive heart failure (G-CHF) registry. Am Heart J. 2020;227:56–63.CrossRefPubMed
27.
go back to reference Oliveira Cardoso Cristiano, Elgalad Abdelmotagaly, Li Ke, Perin Emerson C. Device-based therapy for decompensated heart failure: An updated review of devices in development based on the DRI2P2S classification in Frontiers in Cardiovascular Medicine Vol. 9 2022 https://doi.org/10.3389/fcvm.2022.962839. Oliveira Cardoso Cristiano, Elgalad Abdelmotagaly, Li Ke, Perin Emerson C. Device-based therapy for decompensated heart failure: An updated review of devices in development based on the DRI2P2S classification in Frontiers in Cardiovascular Medicine Vol. 9 2022 https://​doi.​org/​10.​3389/​fcvm.​2022.​962839.
31.
go back to reference Niels T B Scholte, Muhammed T Gürgöze, Dilan Aydin, Dominic A M J Theuns, Olivier C Manintveld, Eelko Ronner, Eric Boersma, Rudolf A de Boer, Robert M A van der Boon, Jasper J Brugts, Telemonitoring for heart failure: a meta-analysis, Eur Heart J., Volume 44, Issue 31, 14 2023, Pages 2911–2926, https://doi.org/10.1093/eurheartj/ehad280. Niels T B Scholte, Muhammed T Gürgöze, Dilan Aydin, Dominic A M J Theuns, Olivier C Manintveld, Eelko Ronner, Eric Boersma, Rudolf A de Boer, Robert M A van der Boon, Jasper J Brugts, Telemonitoring for heart failure: a meta-analysis, Eur Heart J., Volume 44, Issue 31, 14 2023, Pages 2911–2926, https://​doi.​org/​10.​1093/​eurheartj/​ehad280.
33.
go back to reference Bertoldi EG, et al. Cost-effectiveness of cardiac resynchronization therapy in patients with heart failure: the perspective of a middle-income country’s public health system. Int J Cardiol. 2013;163(3):309–15.CrossRefPubMed Bertoldi EG, et al. Cost-effectiveness of cardiac resynchronization therapy in patients with heart failure: the perspective of a middle-income country’s public health system. Int J Cardiol. 2013;163(3):309–15.CrossRefPubMed
34.
go back to reference Mealing S, Woods B, Hawkins N, et al. Cost-effectiveness of implantable cardiac devices in patients with systolic heart failure. Heart. 2016;102:1742–9.CrossRefPubMed Mealing S, Woods B, Hawkins N, et al. Cost-effectiveness of implantable cardiac devices in patients with systolic heart failure. Heart. 2016;102:1742–9.CrossRefPubMed
35.
go back to reference Tomini F, Prinzen F, van Asselt AD. A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure. Eur J Health Econ. 2016 Dec;17(9):1159–1172. https://doi.org/10.1007/s10198-015-0752-3. Tomini F, Prinzen F, van Asselt AD. A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure. Eur J Health Econ. 2016 Dec;17(9):1159–1172. https://​doi.​org/​10.​1007/​s10198-015-0752-3.
Metadata
Title
Economic Considerations of Cardiovascular Implantable Electronic Devices for The Treatment of Heart Failure
Authors
Christian Elsner
Simon Bettin
Roland Tilz
Dennis Häckl
Publication date
25-04-2024

Other articles of this Issue 3/2024

Current Heart Failure Reports 3/2024 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Webinar | 06-02-2024 | 20:00 (CET)

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Sponsored by: Viatris

Developed by: Springer Healthcare