Key result
Extravascular ICDs extend modeled battery longevity vs S-ICDs, reducing lifetime costs by ~25%.
Why the study?
The EV ICD has extended projected battery longevity compared to the S-ICD, but the resulting impact on generator changes, complications, and healthcare costs across countries was uncharacterized.
Does the EV ICD reduce generator replacement surgeries, complications, and healthcare costs compared to the S-ICD in patients requiring ICD therapy?
Does the EV ICD reduce generator replacement surgeries, complications, and healthcare costs compared to the S-ICD in patients requiring ICD therapy?
The extended battery longevity of the EV ICD compared to the S-ICD is projected to significantly reduce the number of generator replacement surgeries, associated complications, and healthcare costs over a patient's lifetime.
INTRODUCTION: The extravascular implantable cardioverter defibrillator (EV ICD) has extended projected battery longevity compared to the subcutaneous implantable cardioverter defibrillator (S-ICD). This study used modeling to characterize the need for generator changes, long-term complications, and overall costs for both the EV ICD and S-ICD in healthcare systems of various countries. METHODS: Battery longevity data were modeled using a Markov model from averages reported in device labeling for the S-ICD and with engineering estimates based on real life usage from EV ICD Pivotal Study patient data to introduce variability. Clinical demographic data were derived from published literature. The primary outcomes were defined as the number of generator replacement surgeries, complications, and total healthcare system costs due to battery depletion over the expected lifetime of patients receiving EV ICD or S-ICD therapy. RESULTS: Average modeled battery longevity was determined to be 7.3 years for the S-ICD versus 11.8 years for the EV ICD. The probability of a complication after a replacement procedure was 1.4%, with an operative mortality rate of 0.02%. The use of EV ICD was associated with 1.4-1.6 fewer replacements on average over an expected patient lifetime as compared to S-ICD and a 24.3%-26.0% reduction in cost. A one-way sensitivity analysis of the model for the US healthcare system found that use of an EV ICD resulted in a reduction in replacement surgeries of greater than 1 (1.1-1.6) along with five-figure cost savings in all scenarios ($18 602-$40 948). CONCLUSION: The longer projected battery life of the EV ICD has the potential to meaningfully reduce long-term morbidity and healthcare resources related to generator changes from the perspective of multiple diverse healthcare systems.
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Knight et al. (2023) studied Patients requiring implantable cardioverter defibrillator therapy. Extravascular implantable cardioverter defibrillator (EV ICD) vs. Subcutaneous implantable cardioverter defibrillator (S-ICD) was evaluated on Number of generator replacement surgeries, complications, and total healthcare system costs due to battery depletion over the expected lifetime. The extravascular ICD extended modeled average battery longevity to 11.8 years versus 7.3 years for the subcutaneous ICD, resulting in 1.4-1.6 fewer replacements and a 24.3%-26.0% cost reduction.
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