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How to truly value implantable cardioverter-defibrillators technology: Up-front cost or daily cost?

Published online by Cambridge University Press:  27 June 2011

Mauro Biffi
Affiliation:
University of Bologna
Matteo Ziacchi
Affiliation:
University of Bologna
Matteo Bertini
Affiliation:
University of Bologna
Beatrice Gardini
Affiliation:
University of Bologna
Andrea Mazzotti
Affiliation:
University of Bologna
Giulia Massaro
Affiliation:
University of Bologna
Cristian Martignani
Affiliation:
University of Bologna
Igor Diemberger
Affiliation:
University of Bologna
Giuseppe Boriani
Affiliation:
University of Bologna
Daniela Corsini
Affiliation:
Policlinico S. Orsola-Malpighi

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.

Type
ASSESSMENTS
Copyright
Copyright © Cambridge University Press 2011

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