title: How to truly value implantable cardioverter-defibrillators technology: up-front cost or daily cost?
abstract: BACKGROUND
  We calculated the daily cost of implantable cardioverter-defibrillators (ICDs) based on their actual longevity to prove whether the up-front cost is a reliable parameter for the ICD purchasing-process. METHODS. Longevity of single chamber (SC), double chamber (DC), and biventricular (BiV) ICDs from Medtronic (MDT), Guidant (GDT), and St. Jude Medical (SJM) was measured in all the patients implanted in years 2000, 2001, 2002 who reached device replacement within December 31, 2009. The cost of each ICD (device + lead/s) was normalized for its own longevity. Data are expressed as median (25th-75th percentile).
  
  
  RESULTS
  A total of 123/153 patients completed the study, 70 percent being alive 8 years after implantation. MDT devices had a superior longevity compared with GDT and SJM (p < .001). Fifty-eight percent of replaced ICDs had a service life at least 1 year shorter than the manufacturers' prediction. Longer-lasting devices had a significantly lower daily cost: €4.8 (4.6-5.7) versus €6.8 (6.2-9.2) and €6.9 (6.2-7.6) for SC (p < .001); €6.9 (6.8-7.7) versus €12.6 (11.8-13.3) and €13.4 (10.3-16.1) for DC; €8.5 (8.3-10.3) versus €15.4 (15.1-15.8) and €14.6 (14.1-14.9) for BiV (p < .005).
  
  
  CONCLUSIONS
  The true cost of ICD treatment is strictly dependent on device longevity, whereas device up-front cost is unreliable. This aspect should be valued in the technology purchasing process, and could set the basis for an outcome-based reimbursement system. Our observations may be the benchmark respectively for ICD longevity and daily ICD cost in future comparisons. Independent observations in the real-life scenario are needed to properly value newer technologic improvements.
authors.affiliation: University of Bologna. mauro.biffi@aosp.bo.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
authors.forename: Matteo
authors.initials: M
authors.lastname: Ziacchi
authors.forename: Matteo
authors.initials: M
authors.lastname: Bertini
authors.forename: Beatrice
authors.initials: B
authors.lastname: Gardini
authors.forename: Andrea
authors.initials: A
authors.lastname: Mazzotti
authors.forename: Giulia
authors.initials: G
authors.lastname: Massaro
authors.forename: Cristian
authors.initials: C
authors.lastname: Martignani
authors.forename: Igor
authors.initials: I
authors.lastname: Diemberger
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.forename: Daniela
authors.initials: D
authors.lastname: Corsini
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D017147:Defibrillators, Implantable / Q000191:economics* / Q000592:standards; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D013997:Time Factors