title: Primary prevention of sudden cardiac death: can we afford the cost of cardioverter-defibrillators? Data from the Search-MI Registry-Italian sub-study.
abstract: BACKGROUND
  Large randomized trials show that in appropriately selected patients with left ventricular dysfunction, implantable cardioverter-defibrillators (ICDs) can improve overall survival at 2-5 years. Since direct implementation of the criteria used in the MADIT II and SCD-HeFT will lead to a marked rise in ICD implants, there is a growing fear that increased use of ICDs may cause a dramatic burden to health care systems. The ICD has traditionally been seen as an expensive form of treatment, which is difficult to accept at the first look. This is mainly due to the nonlinear character of the ICD investment, characterized by high initial expenditure, followed by a deferred pay-off in terms of clinical benefits. Cost-effectiveness analysis may help provide a different perspective on the problem of ICD cost, as may estimation of the daily cost of ICD treatment, assuming a time horizon of 5-7 years--a particularly interesting subject for further registry studies.
  
  
  RESULTS
  Based on real expenditure data from 2002 to 2005, as recorded in the Search-MI Registry-Italian Sub-study of patients implanted on MADIT II indications, we estimated the daily costs associated with the device and leads. Over a 5-7 year time horizon, the average daily cost was estimated to be euro 4.60-euro 6.70. Translation of these figures into U.S. market conditions suggests a daily cost of around $7.90-$11.40.
  
  
  CONCLUSIONS
  These findings appear useful to help evaluate the affordability of ICD in comparison with other therapeutic options in a context of limited available economic resources.
authors.affiliation: Institute of Cardiology, University of Bologna, Azienda Ospedaliera S. Orsola-Malpighi, Bologna. cardio1@med.unibo.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Russo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Lunati
authors.forename: Gianluca
authors.initials: G
authors.lastname: Botto
authors.forename: Alessandro
authors.initials: A
authors.lastname: Proclemer
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vergara
authors.forename: Werner
authors.initials: W
authors.lastname: Rahue
authors.forename: Cristian
authors.initials: C
authors.lastname: Martignani
authors.forename: Renato
authors.initials: R
authors.lastname: Ricci
authors.forename: Massimo
authors.initials: M
authors.lastname: Santini
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control*; D004554:Electric Countershock / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011322:Primary Prevention / Q000191:economics* / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data*