title: Impact of extending device longevity on the long-term costs of implantable cardioverter-defibrillator therapy: a modelling study with a 15-year time horizon.
abstract: OBJECTIVE
  To determine the long-term costs of extending device longevity in four patient populations requiring a single-chamber implantable cardioverter-defibrillator (ICD) or requiring cardiac resynchronization therapy with defibrillation (CRT-D) device over a 15-year time window.
  
  
  RESULTS
  We considered patient populations with an accepted indication for a single-chamber ICD for prevention of sudden cardiac death in the context of preserved (Population A) or impaired (Population B) left ventricular function; or with indication for a CRT-D device in the context of heart failure in New York Heart Association class II (Population C) or III (Population D). Expected patient survival and a cost analysis, including the cost of complications, was undertaken from a hospital perspective. Extended device longevity of 5 vs. 9 years for ICDs (Populations A and B); 4 vs. 7 years for CRT-Ds (Populations C and D) were considered. Over a 15-year time horizon, total, yearly, and per diem savings, per patient, from extending ICD longevity to 9 years were €10 926.91, €728.46, and €1.99 for Population A, and €7661.32, €510.75, and €1.40 for Population B. Total, yearly, and per diem savings from extending CRT-D longevity to 7 years were €13 630.38, €908.69, and €2.49 for Population C, and €10 968.29, €731.22, and €2.00 for Population D. Avoidance of a generator replacement amounted up to 46.6-62.5% of the saving.
  
  
  CONCLUSIONS
  Extending device longevity has an important effect on the long-term cost of device therapy, both for ICD and CRT-D. This has important implications for device choice.
authors.affiliation: Istituto di Cardiologia, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale (DIMES), Università di Bologna, Azienda Ospedaliera S. Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.forename: Frieder
authors.initials: F
authors.lastname: Braunschweig
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Deharo
authors.forename: Francisco
authors.initials: F
authors.lastname: Leyva
authors.forename: Andrzej
authors.initials: A
authors.lastname: Lubinski
authors.forename: Carlo
authors.initials: C
authors.lastname: Lazzaro
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002017:Budgets; D058406:Cardiac Resynchronization Therapy / Q000191:economics*; D058409:Cardiac Resynchronization Therapy Devices / Q000191:economics*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000191:economics*; D004554:Electric Countershock / Q000191:economics* / Q000295:instrumentation; D004867:Equipment Design; D004868:Equipment Failure / Q000191:economics; D017048:Health Care Costs; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D018803:Models, Economic; D011322:Primary Prevention / Q000191:economics* / Q000295:instrumentation; D011474:Prosthesis Design; D011475:Prosthesis Failure; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: Budget; Cardiac resynchronization therapy; Cost; Cost analysis; Device longevity; Economics; Implantable cardioverter-defibrillator; Primary prevention; Sudden death