The cost effectiveness of implantable cardioverter defibrillators: a systematic review of economic evaluations.
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.


METHODS
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.


CONCLUSIONS
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.
Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 115 21, Athens, Greece.
Fotini
F
Gialama
Panagiotis
P
Prezerakos
Nikos
N
Maniadakis
D000889:Anti-Arrhythmia Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D016206:Databases, Bibliographic; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000191:economics*; D006331:Heart Diseases / Q000150:complications / Q000191:economics / Q000517:prevention & control; D006801:Humans; D011322:Primary Prevention / Q000191:economics / Q000379:methods; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment / Q000379:methods; D055502:Secondary Prevention / Q000191:economics / Q000379:methods
D000889:Anti-Arrhythmia Agents