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Economic evaluations of implantable cardioverter defibrillators: a systematic review

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Abstract

The aim of this paper was to review the cost-effectiveness studies of implantable cardioverter defibrillators (ICD) for primary or secondary prevention of sudden cardiac death (SCD). A systematic review of the literature published in English or Spanish was performed by electronically searching MEDLINE and MEDLINE in process, EMBASE, NHS-EED, and EconLit. Some keywords were implantable cardioverter defibrillator, heart failure, heart arrest, myocardial infarction, arrhythmias, syncope, sudden death. Selection criteria were the following: (1) full economic evaluations published after 1995, model-based studies or alongside clinical trials (2) that explored the cost-effectiveness of ICD with or without associated treatment compared with placebo or best medical treatment, (3) in adult patients for primary or secondary prevention of SCD because of ventricular arrhythmias. Studies that fulfilled these criteria were reviewed and data were extracted by two reviewers. The methodological quality of the studies was assessed and a narrative synthesis was prepared. In total, 24 studies were included: seven studies on secondary prevention and 18 studies on primary prevention. Seven studies were performed in Europe. For secondary prevention, the results showed that the ICD is considered cost-effective in patients with more risk. For primary prevention, the cost-effectiveness of ICD has been widely studied, but uncertainty about its cost-effectiveness remains. The cost-effectiveness ratios vary between studies depending on the patient characteristics, methodology, perspective, and national settings. Among the European studies, the conclusions are varied, where the ICD is considered cost-effective or not dependent on the study.

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Acknowledgments

The authors would like to thank Melany Worbes-Cerezo, Pedro Serrano-Aguilar, and Andrés Fernández-Ramos. The authors would also like to thank Jason Willis-Lee for copyediting support. This work was partly funded by Instituto de Salud Carlos III and Fundación Canaria de Investigación y Salud (FUNCIS), Spain.

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Authors and Affiliations

  1. Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Camino Candelaria Nº 44, 1ª planta, El Rosario, 38109, Santa Cruz De Tenerife, Canary Islands, Spain

    Lidia García-Pérez, Pilar Pinilla-Domínguez & Renata Linertová

  2. Fundación Canaria de Investigación y Salud (FUNCIS), Canary Islands, Spain

    Lidia García-Pérez & Renata Linertová

  3. Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain

    Lidia García-Pérez, Renata Linertová & Iñaki Imaz-Iglesia

  4. Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Spain

    Lidia García-Pérez & Renata Linertová

  5. CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

    Pilar Pinilla-Domínguez

  6. Servicio de Cardiología, Hospital Universitario de Gran Canaria Dr Negrín, Canary Islands, Spain

    Antonio García-Quintana & Eduardo Caballero-Dorta

  7. Unidad de Calidad y Seguridad del Paciente, Hospital Universitario Nuestra Señora de Candelaria, Canary Islands, Spain

    F. Javier García-García

  8. Agencia de Evaluación de Tecnologías Sanitarias (AETS), Instituto de Salud Carlos III (ISCIII), Madrid, Spain

    Iñaki Imaz-Iglesia

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  1. Lidia García-Pérez
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  2. Pilar Pinilla-Domínguez
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Correspondence to Lidia García-Pérez.

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García-Pérez, L., Pinilla-Domínguez, P., García-Quintana, A. et al. Economic evaluations of implantable cardioverter defibrillators: a systematic review. Eur J Health Econ 16, 879–893 (2015). https://doi.org/10.1007/s10198-014-0637-x

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