title: A propensity matched case-control study comparing efficacy, safety and costs of the subcutaneous vs. transvenous implantable cardioverter defibrillator.
abstract: BACKGROUND
  Subcutaneous implantable cardioverter defibrillators (S-ICD) have become more widely available. However, comparisons with conventional transvenous ICDs (TV-ICD) are scarce.
  
  
  METHODS
  We conducted a propensity matched case-control study including all patients that underwent S-ICD implantation over a five-year period in a single tertiary centre. Controls consisted of all TV-ICD implant patients over a contemporary time period excluding those with pacing indication, biventricular pacemakers and those with sustained monomorphic ventricular tachycardia requiring anti-tachycardia pacing. Data was collected on device-related complications and mortality rates. A cost efficacy analysis was performed.
  
  
  RESULTS
  Sixty-nine S-ICD cases were propensity matched to 69 TV-ICD controls. During a mean follow-up of 31±19 (S-ICD) and 32±21months (TV-ICD; p=0.88) there was a higher rate of device-related complications in the TV-ICD group predominantly accounted for by lead failures (n=20, 29% vs. n=6, 9%; p=0.004). The total mean cost for each group, including the complication-related costs was £9967±4511 ($13,639±6173) and £12,601±1786 ($17,243±2444) in the TV-ICD and S-ICD groups respectively (p=0.0001). Even though more expensive S-ICD was associated with a relative risk reduction of device-related complication of 70% with a HR of 0.30 (95%CI 0.12-0.76; p=0.01) compared to TV-ICDs.
  
  
  CONCLUSIONS
  TV-ICDs are associated with increased device-related complication rates compared to a propensity matched S-ICD group during a similar follow-up period. Despite the existing significant difference in unit cost of the S-ICD, overall S-ICD costs may be mitigated versus TV-ICDs over a longer follow-up period.
authors.affiliation: Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
authors.forename: S
authors.initials: S
authors.lastname: Honarbakhsh
authors.affiliation: Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
authors.forename: R
authors.initials: R
authors.lastname: Providencia
authors.affiliation: Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
authors.forename: N
authors.initials: N
authors.lastname: Srinivasan
authors.affiliation: Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
authors.forename: S
authors.initials: S
authors.lastname: Ahsan
authors.affiliation: Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
authors.forename: M
authors.initials: M
authors.lastname: Lowe
authors.affiliation: Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
authors.forename: E
authors.initials: E
authors.lastname: Rowland
authors.affiliation: Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Hunter
authors.affiliation: Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
authors.forename: M
authors.initials: M
authors.lastname: Finlay
authors.affiliation: Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
authors.forename: O
authors.initials: O
authors.lastname: Segal
authors.affiliation: Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Earley
authors.affiliation: Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
authors.forename: A
authors.initials: A
authors.lastname: Chow
authors.affiliation: Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Schilling
authors.affiliation: Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK. Electronic address: p.lambiase@ucl.ac.uk.
authors.forename: P D
authors.initials: PD
authors.lastname: Lambiase
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D016022:Case-Control Studies; D002423:Cause of Death; D003362:Cost-Benefit Analysis; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000191:economics; D004554:Electric Countershock / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011379:Prognosis; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome
keywords: Device-related complications; Implantable cardioverter defibrillator; Lead; Sudden cardiac death