Key result
Medtronic ICDs demonstrated superior longevity compared to Guidant and St. Jude Medical devices (p<0.001), resulting in significantly lower daily costs across all device types.
Why the study?
Does the actual longevity of different ICD models affect their daily cost compared to up-front cost?
Cohort (n=123)
Does the actual longevity of different ICD models affect their daily cost compared to up-front cost?
p-value: p=<.001
The true cost of ICD treatment depends strictly on device longevity rather than up-front cost, suggesting purchasing decisions should consider actual device lifespan.
Longevity may drive lower daily ICD costs over upfront price; leaves open whether this alters selection in prospective data.
BACKGROUND: We calculated the daily cost of implantable cardioverter-defibrillators (ICDs) based on their actual longevity to prove whether the up-front cost is a reliable parameter for the ICD purchasing-process. METHODS. Longevity of single chamber (SC), double chamber (DC), and biventricular (BiV) ICDs from Medtronic (MDT), Guidant (GDT), and St. Jude Medical (SJM) was measured in all the patients implanted in years 2000, 2001, 2002 who reached device replacement within December 31, 2009. The cost of each ICD (device + lead/s) was normalized for its own longevity. Data are expressed as median (25th-75th percentile). RESULTS: A total of 123/153 patients completed the study, 70 percent being alive 8 years after implantation. MDT devices had a superior longevity compared with GDT and SJM (p < .001). Fifty-eight percent of replaced ICDs had a service life at least 1 year shorter than the manufacturers' prediction. Longer-lasting devices had a significantly lower daily cost: €4.8 (4.6-5.7) versus €6.8 (6.2-9.2) and €6.9 (6.2-7.6) for SC (p < .001); €6.9 (6.8-7.7) versus €12.6 (11.8-13.3) and €13.4 (10.3-16.1) for DC; €8.5 (8.3-10.3) versus €15.4 (15.1-15.8) and €14.6 (14.1-14.9) for BiV (p < .005). CONCLUSIONS: The true cost of ICD treatment is strictly dependent on device longevity, whereas device up-front cost is unreliable. This aspect should be valued in the technology purchasing process, and could set the basis for an outcome-based reimbursement system. Our observations may be the benchmark respectively for ICD longevity and daily ICD cost in future comparisons. Independent observations in the real-life scenario are needed to properly value newer technologic improvements.
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Biffi et al. (2011) conducted a cohort in Implantable cardioverter-defibrillator (ICD) indication (n=123). Medtronic (MDT) ICDs vs. Guidant (GDT) and St. Jude Medical (SJM) ICDs was evaluated on Device longevity and daily cost (p=<.001). Medtronic ICDs demonstrated superior longevity compared to Guidant and St. Jude Medical devices (p<0.001), resulting in significantly lower daily costs across all device types.
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