Conclusions
The low risk of ICD implantation and the evidence that these devices successfully terminate life-threatening ventricular tachyarrhythmias have prompted the use of ICDs in the primary prevention of sudden death in specific clinical conditions associated with a substantially increased risk of sudden arrhythmic death, including non-ischaemic cardiomyopathy. Despite continuing price reductions, cost is likely to remain a major determinant of the complete acceptance and implementation of ICD therapy. Therefore, the problem of how broadened evidence-based indications for implantation can be translated into the ‘real world’ remains to be addressed and resolved, considering currently available economic resources. Cost-effectiveness analysis provides the most appropriate tool for weighing costs against benefits for both ICD and CRT-D and should be directed towards specifically defined subsets of patients, including those with non-ischaemic cardiomyopathy.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Bardy GH, Lee KL, Mark DB et al (2005) Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 352:225–237
Bristow MR, Saxon LA, Boehmer J et al (2004) Cardiac resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 350:2140–2150
Cleland JG, Daubert JC, Erdmann E et al (2005) The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 352:1539–1549
Desai AS, Fang JC, Maisel WH et al (2004) Implantable defibrillators for the prevention of mortality in patients with nonischemic cardiomyopathy: a meta-analysis of randomized controlled trials. JAMA 292:2874–2479
Boriani G, Biffi M, Martignani C et al (2001) Cost-effectiveness of implantable cardioverter-defibrillators. Eur Heart J 22:990–996
Boriani G, Biffi M, Martignani C et al (2003) Cardioverter-defibrillators after MADIT II: the balance between weight of evidence and treatment costs. Eur J Heart Failure 5:419–425
Hlatky MA, Bigger JT (2001) Cost-effectiveness of the implantable cardioverter defibrillator? Lancet 357:1817–1818
Boriani G, Biffi M, Martignani C (2005) Long-term efficacy of cardioverter-defibrillators: implications for cost-effectiveness. Circulation 111:e26
Essebag V, Eisenberg MJ (2003) Expanding indications for defibrillators after myocardial infarction: risk stratification and cost effectiveness. Card Electrophysiol Rev 7:43–48
Mark DB (2004) Cost-effectiveness of ICD therapy in the Sudden Death in Heart Failure Trial (SCD-HeFT). Presented at the Late Breaking Trials session of the Annual Meeting of the American Heart Association, November 10, 2004, New Orleans, LA, USA
Boriani G, Biffi M, Martignani C et al (2004) Cardiac resynchronization by pacing: an electrical treatment of heart failure. Int J Cardiol 94:151–161
Auricchio A, Abraham WT (2004) Cardiac resynchronization therapy: current state of the art: cost versus benefit. Circulation 109:300–307
McAlister FA, Ezekowitz JA, Wiebe N et al (2004) Systematic review: cardiac resynchronization in patients with symptomatic heart failure. Ann Intern Med 141:381–390
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2006 Springer-Verlag Italia
About this chapter
Cite this chapter
Boriani, G. et al. (2006). Cost-Effectiveness and Aspects of Health Economics in Primary Prevention: What Is the Case of Dilated Cardiomyopathy?. In: Raviele, A. (eds) Cardiac Arrhythmias 2005. Springer, Milano. https://doi.org/10.1007/88-470-0371-7_55
Download citation
DOI: https://doi.org/10.1007/88-470-0371-7_55
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-0370-5
Online ISBN: 978-88-470-0371-2
eBook Packages: MedicineMedicine (R0)