Cost‐minimization analysis of a wearable cardioverter defibrillator in adult patients undergoing ICD explant procedures: Clinical and economic implications. Issue 11 (24th August 2021)

• Record Type: Journal Article
• Authors: Boriani, Giuseppe; Mantovani, Lorenzo Giovanni; Cortesi, Paolo Angelo; De Ponti, Roberto; D'Onofrio, Antonio; Arena, Giuseppe; Curnis, Antonio; Forleo, Giovanni; Guerra, Federico; Porcu, Maurizio; Sgarito, Giuseppe; Botto, Giovanni Luca
• Is Part Of: Clinical cardiology. Volume 44:Issue 11(2021)
• Page Start: 1497
• Page End: 1505
• Publication Date: 2021-08-24
• Subjects: cost‐minimization analysis -- health technology assessment -- ICD explant -- sudden cardiac death -- ventricular arrhythmia -- wearable cardioverter defibrillator; Cardiology -- Periodicals; 616.12005
• DOI: 10.1002/clc.23709
• Languages: English
• ISSNs: 0160-9289

Abstract

Abstract: Aims: Patients with permanently increased risk of sudden cardiac death (SCD) can be protected by implantable cardioverter defibrillators (ICD). If an ICD must be removed due to infection, for example, immediate reimplantation might not be possible or indicated. The wearable cardioverter defibrillator (WCD) is an established, safe and effective solution to protect patients from SCD during this high‐risk bridging period. Very few economic evaluations on WCD use are currently available. Methods: We conducted a systematic review to evaluate the available evidence of WCD in patients undergoing ICD explant/lead extraction. Additionally, a decision model was developed to compare use and costs of the WCD with standard therapy (in‐hospital stay). For this purpose, a cost‐minimization analysis was conducted, and complemented by a one‐way sensitivity analysis. Results: In the base case scenario, the WCD was less expensive compared to standard therapy. The cost‐minimization analysis showed a cost reduction of €1782 per patient using the WCD. If costs of standard care were changed, cost savings associated with the WCD varied from €3500 to €0, assuming costs for standard care of €6800 to €3600. Conclusion: After ICD explantation, patients can be safely and effectively protected from SCD after hospital discharge through WCD utilization. Furthermore, the use of a WCD for this patient group is cost saving when compared to standard therapy.