Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
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.
ADVANCED SEARCH
Log in
Top
Applied Health Economics and Health Policy
Published in: Applied Health Economics and Health Policy 1/2014

01-02-2014 | Systematic Review

The Cost Effectiveness of Implantable Cardioverter Defibrillators: A Systematic Review of Economic Evaluations

Authors: Fotini Gialama, Panagiotis Prezerakos, Nikos Maniadakis

Published in: Applied Health Economics and Health Policy | Issue 1/2014

Login to get access

Abstract

Background

Sudden cardiac death (SCD) is the most common cause of death in developed countries, with more than 3 million people dying yearly. Implantable cardioverter defibrillators (ICDs) are considered to be an effective treatment in the primary and secondary prevention of SCD; however, their cost is considerable and this poses questions regarding whether they are worth the investment relative to less expensive pharmacotherapy.

Objective

The aim of this systematic review is to investigate existing evidence regarding the cost effectiveness of ICD therapy and to identify the key drivers of cost effectiveness, for the purpose of informing interested policy and decision makers.

Methodology

A systematic review of the literature concerning the cost effectiveness of ICDs was undertaken. Electronic databases, including PubMed, Cochrane and Health Economic Evaluations Database were searched based on appropriate terms and their combinations. Economic evaluation studies that examined the cost effectiveness of ICDs were selected and 34 were included for evaluation.

Results

Findings from the present analysis show that ICD therapy, in properly selected patients who are at high risk of sudden cardiac death, is associated with similar or better cost-effectiveness ratios compared with other well accepted conventional treatments. The cost effectiveness of ICDs is influenced by several factors, including ICD efficacy and safety, impact on patient quality of life, device original implantation cost, frequency and cost of battery replacement, patient demographics and risk profile and analysis time horizon.

Conclusion

ICDs may represent a cost-effective option relative to pharmacotherapy in appropriately selected patient groups. The cost-effectiveness ratios appear to be at acceptable and comparable levels to other established treatments in cardiovascular and non-cardiovascular diseases. However, cost effectiveness is highly related to several factors and hence economic efficiency is highly dependent on conditions that need to be fulfilled for each individual case in medical practice. The aforementioned factors and technological advances imply that to ensure cost-effective use of ICD therapy, continuous research is needed.
Appendix
Available only for authorised users
Literature
1.
2.
Josephson M, Wellens HJ. Implantable defibrillators and sudden cardiac death. Circulation. 2004;109:2685–91.PubMedCrossRef
3.
Myerburg RJ et al. Frequency of sudden cardiac death and profiles of risk. Am J Cardiol. 1997;80(suppl. 5B):10F–9F.
4.
Weisfeldt ML, Zieman SJ. Advances in the prevention and treatment of cardiovascular disease. Health Aff (Millwood). 2007;26(1):25–37.CrossRef
5.
6.
Reiffel J, Dizon J. The implantable cardioverter-defibrillator: patient perspective. Circulation. 2002;105(9):1022–4.PubMedCrossRef
7.
Epstein A, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. J Am Coll Cardiol. 2008;51(21).
8.
Liberati A, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7).
9.
Ofman JJ, et al. Examining the value and quality of health economic analyses: implications of utilizing the QHES. J Manage Care Pharm. 2003;9(1):53–61.
10.
Kupersmith J, et al. Evaluating and improving the cost-effectiveness of the implantable cardioverter-defibrillator. Am Heart J. 1995;130(3 Pt 1):507–15.PubMedCrossRef
11.
Kuppermann M, et al. An analysis of the cost effectiveness of the implantable defibrillator. Circulation. 1990;81(1):91–100.PubMedCrossRef
12.
Larsen G, et al. Cost-effectiveness of the implantable cardioverter-defibrillator versus antiarrhythmic drugs in survivors of serious ventricular tachyarrhythmias: results of the Antiarrhythmics Versus Implantable Defibrillators (AVID) economic analysis substudy. Circulation. 2002;105(17):2049–57.PubMedCrossRef
13.
O’Brien BJ, Buxton MJ, Rushby JA. Cost effectiveness of the implantable cardioverter defibrillator: a preliminary analysis. Br Heart J. 1992;68(2):241–5.PubMedCentralPubMedCrossRef
14.
O’Brien BJ, et al. Cost-effectiveness of the implantable cardioverter-defibrillator: results from the Canadian Implantable Defibrillator Study (CIDS). Circulation. 2001;103(10):1416–21.PubMedCrossRef
15.
Sheldon R, et al. Effect of clinical risk stratification on cost-effectiveness of the implantable cardioverter-defibrillator: the Canadian implantable defibrillator study. Circulation. 2001;104(14):1622–6.PubMedCrossRef
16.
Weiss JP, et al. Effectiveness and cost-effectiveness of implantable cardioverter defibrillators in the treatment of ventricular arrhythmias among medicare beneficiaries. Am J Med. 2002;112(7):519–27.PubMedCrossRef
17.
Wever EF, et al. Cost-effectiveness of implantable defibrillator as first-choice therapy versus electrophysiologically guided, tiered strategy in postinfarct sudden death survivors. A randomized study. Circulation. 1996;93(3):489–96.PubMedCrossRef
18.
Larsen GC, et al. Cost-effectiveness of the implantable cardioverter-defibrillator: effect of improved battery life and comparison with amiodarone therapy. J Am Coll Cardiol. 1992;19(6):1323–34.PubMedCrossRef
19.
Owens DK, et al. Cost-effectiveness of implantable cardioverter defibrillators relative to amiodarone for prevention of sudden cardiac death. Ann Intern Med. 1997;126(1):1–12.PubMedCrossRef
20.
Owens DK, et al. Effect of risk stratification on cost-effectiveness of the implantable cardioverter defibrillator. Am Heart J. 2002;144(3):440–8.PubMedCrossRef
21.
Cowie MR, et al. Lifetime cost-effectiveness of prophylactic implantation of a cardioverter defibrillator in patients with reduced left ventricular systolic function: results of Markov modelling in a European population. Europace. 2009;11(6):716–26.PubMedCrossRef
22.
Gandjour A, et al. Cost-effectiveness of implantable defibrillators after myocardial infarction based on 8-year follow-up data (MADIT II). Value Health. 2011;14(6):812–7.PubMedCrossRef
23.
Mark DB, et al. 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(2):135–42.PubMedCrossRef
24.
Neyt M, et al. Cost effectiveness of implantable cardioverter-defibrillators for primary prevention in a Belgian context. Appl Health Econ Health Policy. 2008;6(1):67–80.PubMedCrossRef
25.
Ribeiro RA, et al. Cost-effectiveness of implantable cardioverter-defibrillators in Brazil: primary prevention analysis in the public sector. Value Health. 2010;13(2):160–8.PubMedCrossRef
26.
Ribeiro RA, et al. Cost-effectiveness of implantable cardioverter defibrillators in Brazil in the public and private sectors. Arq Bras Cardiol. 2010;95(5):577–86.PubMedCrossRef
27.
Sanders GD, et al. Potential cost-effectiveness of prophylactic use of the implantable cardioverter defibrillator or amiodarone after myocardial infarction. Ann Intern Med. 2001;135(10):870–83.PubMedCrossRef
28.
Sanders GD, Hlatky MA, Owens DK. Cost-effectiveness of implantable cardioverter-defibrillators. N Engl J Med. 2005;353(14):1471–80.PubMedCrossRef
29.
Sanders GD, et al. Cost-effectiveness of implantable cardioverter defibrillators in patients > or = 65 years of age. Am Heart J. 2010;160(1):122–31.PubMedCrossRef
30.
Sanders GD, et al. Special report: cost-effectiveness of implantable cardioverter-defibrillators in a MADIT-II population. Technol Eval Cent Assess Program Exec Summ. 2004;19(3):1–2.
31.
Wang K, et al. Cost-effectiveness of implantable cardioverter-defibrillators in Brugada syndrome treatment. J Med Syst. 2008;32(1):51–7.PubMedCrossRef
32.
You JJ, et al. Life expectancy gains and cost-effectiveness of implantable cardioverter/defibrillators for the primary prevention of sudden cardiac death in patients with hypertrophic cardiomyopathy. Am Heart J. 2007;154(5):899–907.PubMedCrossRef
33.
Al-Khatib SM, et al. Clinical and economic implications of the Multicenter Automatic Defibrillator Implantation Trial-II. Ann Intern Med. 2005;142(8):593–600.PubMedCrossRef
34.
Groeneveld PW, et al. Outcomes and costs of implantable cardioverter-defibrillators for primary prevention of sudden cardiac death among the elderly. Heart Rhythm. 2008;5(5):646–53.PubMedCrossRef
35.
Mushlin AI, et al. The cost-effectiveness of automatic implantable cardiac defibrillators: results from MADIT. Multicenter Automatic Defibrillator Implantation Trial. Circulation. 1998;97(21):2129–35.PubMedCrossRef
36.
Zwanziger J, et al. The cost effectiveness of implantable cardioverter-defibrillators: results from the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II. J Am Coll Cardiol. 2006;47(11):2310–8.PubMedCrossRef
37.
Chen L, Hay JW. Cost-effectiveness of primary implanted cardioverter defibrillator for sudden death prevention in congestive heart failure. Cardiovasc Drugs Ther. 2004;18(2):161–70.PubMedCrossRef
38.
Feingold B, et al. Cost-effectiveness of implantable cardioverter-defibrillators in children with dilated cardiomyopathy. J Card Fail. 2010;16(9):734–41.PubMedCentralPubMedCrossRef
39.
Goldenberg I, et al. Cost-effectiveness of implanted defibrillators in young people with inherited cardiac arrhythmias. Ann Noninvasive Electrocardiol. 2005;10:67–83.PubMedCrossRef
40.
Smith T, et al. The cost-effectiveness of primary prophylactic implantable defibrillator therapy in patients with ischaemic or non-ischaemic heart disease: a European analysis. Eur Heart J. 2013;34(3):211–9.PubMedCrossRef
41.
Caro JJ, et al. Cost–benefit analysis of preventing sudden cardiac deaths with an implantable cardioverter defibrillator versus amiodarone. Value Health. 2007;10(1):13–22.PubMedCrossRef
42.
Deniz HB, et al. Cost–benefit analysis of primary prevention of sudden cardiac death with an implantable cardioverter defibrillator versus amiodarone in Canada. Curr Med Res Opin. 2009;25(3):617–26.PubMedCrossRef
43.
Goldberger Z, et al. Cost advantage of dual-chamber versus single-chamber cardioverter-defibrillator implantation. J Am Coll Cardiol. 2005;46(5):850–7.PubMedCrossRef
44.
Valenti R, et al. Impact of the implantable cardioverter-defibrillator on rehospitalizations. Eur Heart J. 1996;17(10):1565–71.PubMedCrossRef
45.
Tung R, Zimetbaum P, Josephson ME. A critical appraisal of implantable cardioverter-defibrillator therapy for the prevention of sudden cardiac death. J Am Coll Cardiol. 2008;52(14):1111–21.PubMedCrossRef
46.
Irvine J, et al. Quality of life in the Canadian Implantable Defibrillator Study (CIDS). Am Heart J. 2002;144(2):282–9.PubMedCrossRef
47.
Namerow PB, et al. Quality-of-life six months after CABG surgery in patients randomized to ICD versus no ICD therapy: findings from the CABG Patch Trial. Pacing Clin Electrophysiol. 1999;22(9):1305–13.PubMedCrossRef
48.
Boriani G, et al. Implantable cardioverter defibrillators: from evidence of trials to clinical practice. Eur Heart J Suppl. 2007;9:166–73.
49.
Moss AJ. Implantable cardioverter defibrillator therapy: the sickest patients benefit the most. Circulation. 2000;101:1638–40.PubMedCrossRef
50.
Lee DS, et al. Effect of cardiac and noncardiac conditions on survival after defibrillator implantation. J Am Coll Cardiol. 2007;49(25):2408–15.PubMedCrossRef
51.
Chan PS, et al. Impact of age and medical comorbidity on the effectiveness of implantable cardioverter-defibrillators for primary prevention. Circ Cardiovasc Qual Outcomes. 2009;2(1):16–24.PubMedCrossRef
52.
Mezu U, et al. Effectiveness of implantable defibrillators in octogenarians and nonagenarians for primary prevention of sudden cardiac death. Am J Cardiol. 2011;108(5):718–22.PubMedCrossRef
53.
Hartling L, et al. Challenges in systematic reviews of therapeutic devices and procedures. Ann Intern Med. 2005;142(12 Pt 2):1100–11.PubMedCrossRef
54.
Pignone M, et al. Challenges in systematic reviews of economic analyses. Ann Intern Med. 2005;142(12 Pt 2):1073–9.PubMedCrossRef
55.
Stanton MS, Bell GK. Economic outcomes of implantable cardioverter-defibrillators. Circulation. 2000;101(9):1067–74.PubMedCrossRef
56.
Anderson R. Systematic reviews of economic evaluations: utility or futility? Health Econ. 2010;19(3):350–64.PubMedCrossRef
57.
Mark DB, Hlatky MA. Medical economics and the assessment of value in cardiovascular medicine: Part II. Circulation. 2002;106(5):626–30.PubMedCrossRef
58.
Mark DB, Hlatky MA. Medical economics and the assessment of value in cardiovascular medicine: part I. Circulation. 2002;106(4):516–20.PubMedCrossRef
59.
National Institute for Health and Clinical Excellence. Guide to the methods of technology appraisal; 2008.
60.
Hutubessy R, Chisholm D, Edejer TT. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost Eff Resour Alloc. 2003;1(1):8.PubMedCentralPubMedCrossRef
61.
62.
Adang E, et al. Cost-effectiveness analysis in relation to budgetary constraints and reallocative restrictions. Health Policy. 2005;74(2):146–56.PubMedCrossRef
63.
64.
Boriani G, et al. Cardioverter-defibrillators after MADIT-II: the balance between weight of evidence and treatment costs. Eur J Heart Fail. 2003;5(4):419–25.PubMedCrossRef
65.
Boriani G, et al. Cost-effectiveness of implantable cardioverter-defibrillators. Eur Heart J. 2001;22(12):990–6.PubMedCrossRef
66.
Hlatky MA, Bigger T. Cost-effectiveness of the implantable cardioverter defibrillator? Lancet. 2001;357(9271):1817–8.PubMedCrossRef
Metadata
Title
The Cost Effectiveness of Implantable Cardioverter Defibrillators: A Systematic Review of Economic Evaluations
Authors
Fotini Gialama
Panagiotis Prezerakos
Nikos Maniadakis
Publication date
01-02-2014
Publisher
Springer International Publishing
Published in
Applied Health Economics and Health Policy / Issue 1/2014
Print ISSN: 1175-5652
Electronic ISSN: 1179-1896
DOI
https://doi.org/10.1007/s40258-013-0069-2

Other articles of this Issue 1/2014

Applied Health Economics and Health Policy 1/2014 Go to the issue

Original Research Article

Cost-Effectiveness Analysis of Clinically Indicated Versus Routine Replacement of Peripheral Intravenous Catheters

Original Research Article

Budget Impact Analysis of Liposomal Amphotericin B and Amphotericin B Lipid Complex in the Treatment of Invasive Fungal Infections in the United States

Original Research Article

How Important Is Health Status in Defining Quality of Life for Older People? An Exploratory Study of the Views of Older South Australians

Systematic Review

A Critical Systematic Review of Budget Impact Analyses on Drugs in the EU Countries

Systematic Review

Insulin Glargine in a Brazilian State: Should the Government Disinvest? An Assessment Based on a Systematic Review

Practical Application

Propensity-Score Matching in Economic Analyses: Comparison with Regression Models, Instrumental Variables, Residual Inclusion, Differences-in-Differences, and Decomposition Methods