title: Economic evaluations of implantable cardioverter defibrillators: a systematic review.
abstract: The aim of this paper was to review the cost-effectiveness studies of implantable cardioverter defibrillators (ICD) for primary or secondary prevention of sudden cardiac death (SCD). A systematic review of the literature published in English or Spanish was performed by electronically searching MEDLINE and MEDLINE in process, EMBASE, NHS-EED, and EconLit. Some keywords were implantable cardioverter defibrillator, heart failure, heart arrest, myocardial infarction, arrhythmias, syncope, sudden death. Selection criteria were the following: (1) full economic evaluations published after 1995, model-based studies or alongside clinical trials (2) that explored the cost-effectiveness of ICD with or without associated treatment compared with placebo or best medical treatment, (3) in adult patients for primary or secondary prevention of SCD because of ventricular arrhythmias. Studies that fulfilled these criteria were reviewed and data were extracted by two reviewers. The methodological quality of the studies was assessed and a narrative synthesis was prepared. In total, 24 studies were included: seven studies on secondary prevention and 18 studies on primary prevention. Seven studies were performed in Europe. For secondary prevention, the results showed that the ICD is considered cost-effective in patients with more risk. For primary prevention, the cost-effectiveness of ICD has been widely studied, but uncertainty about its cost-effectiveness remains. The cost-effectiveness ratios vary between studies depending on the patient characteristics, methodology, perspective, and national settings. Among the European studies, the conclusions are varied, where the ICD is considered cost-effective or not dependent on the study.
authors.affiliation: Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, El Rosario, 38109, Santa Cruz De Tenerife, Canary Islands, Spain. lidia.garciaperez@sescs.es.|Fundación Canaria de Investigación y Salud (FUNCIS), Canary Islands, Spain. lidia.garciaperez@sescs.es.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain. lidia.garciaperez@sescs.es.|Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain. lidia.garciaperez@sescs.es.
authors.forename: Lidia
authors.initials: L
authors.lastname: García-Pérez
authors.affiliation: Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, El Rosario, 38109, Santa Cruz De Tenerife, Canary Islands, Spain.|CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Pinilla-Domínguez
authors.affiliation: Servicio de Cardiología, Hospital Universitario de Gran Canaria Dr Negrín, Canary Islands, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: García-Quintana
authors.affiliation: Servicio de Cardiología, Hospital Universitario de Gran Canaria Dr Negrín, Canary Islands, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Caballero-Dorta
authors.affiliation: Unidad de Calidad y Seguridad del Paciente, Hospital Universitario Nuestra Señora de Candelaria, Canary Islands, Spain.
authors.forename: F Javier
authors.initials: FJ
authors.lastname: García-García
authors.affiliation: Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, El Rosario, 38109, Santa Cruz De Tenerife, Canary Islands, Spain.|Fundación Canaria de Investigación y Salud (FUNCIS), Canary Islands, Spain.|Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.|Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain.
authors.forename: Renata
authors.initials: R
authors.lastname: Linertová
authors.affiliation: Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.|Agencia de Evaluación de Tecnologías Sanitarias (AETS), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
authors.forename: Iñaki
authors.initials: I
authors.lastname: Imaz-Iglesia
mesh_terms: D003362:Cost-Benefit Analysis; D017147:Defibrillators, Implantable / Q000191:economics*; D006333:Heart Failure / Q000517:prevention & control*; D006801:Humans
keywords: Cost-effectiveness; Heart failure; Implantable cardioverter defibrillator; Prevention; Sudden cardiac death; Systematic review