title: The cost of implantable defibrillators: perceptions and reality.
abstract: OBJECTIVE
  Recent guidelines have recommended more wide-ranging indications for the use of implantable cardioverter defibrillator (ICD) therapy, yet even more restrained previous guidelines have not been implemented for a variety of reasons.
  
  
  RESULTS
  This brief review critically examines the reasons most frequently put forward to explain this failure. Contrary to the frequently repeated speculation that the risk stratification for sudden death and hence prophylactic placement of ICDs is reasonably accurate, there is little cost difference between pharmacotherapy and ICD treatment over the long term. ICD therapy does not utilize an undue proportion of the healthcare budget, and the healthcare systems in Europe can afford this therapy.
  
  
  CONCLUSIONS
  Financial reasons are neither accurate nor adequate explanations for the failure of the European medical community to implement European guidelines for the implantation of ICDs for primary and secondary prevention of sudden cardiac death.
authors.affiliation: St George's University of London, Cranmer Terrace, London SW17 0RE, UK. jcamm@sgul.ac.uk
authors.forename: John
authors.initials: J
authors.lastname: Camm
authors.forename: Helmut
authors.initials: H
authors.lastname: Klein
authors.forename: Seah
authors.initials: S
authors.lastname: Nisam
mesh_terms: D002317:Cardiovascular Agents / Q000191:economics; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000191:economics*; D016527:Drug Costs; D005102:Health Expenditures; D006801:Humans; D019057:Quality-Adjusted Life Years
chemical_list: D002317:Cardiovascular Agents