Is the Implantable Defibrillator Cost-effective?

Abstract

In the two decades since Mirowski and colleagues introduced the implantable cardioverter defíbrillator (ICD) into clinical practice [1], multiple clinical studies have established ICD therapy as the treatment of choice compared to any alternative treatment modality. Specifically, the ICD has been proven to be far superior in terms of overall survival and protection against sudden cardiac death from ventricular tachyarrhythmias in patients resuscitated from ventricular fibrillation or ventricular tachycardia (VF/VT) [2–12] as well as in patients identified as being at high risk despite not yet having suffered spontaneous episodes of VT or VF [13, 14]. However, the relatively high up-front costs — hospitalization and device - have focused much attention on the issue of the cost-effectiveness of ICD therapy [15]. Comparison of the cost-effectiveness of ICD therapy to that of presently well accepted medical therapies, particularly alternatives to ICD therapy, provides results which are enlightening and even surprising. Our article here will cover two main aspects of this question: (1) the conclusions and implications of the published studies on the cost-effectiveness of ICD therapy (ICD C-E); (2) the costs associated with ICD therapy compared to medical management and to other therapies.