New device indications: practice and cost implications in Europe.

The potential clinical value of implantable devices, for both diagnostic and therapeutic uses in cardiology practice, has increased greatly with technical innovation. This coupled with an increased recipient population size (as the population ages) and increased referral rates (as that population and its healthcarers are educated), has increased the demand for such devices and the associated economic burden is impacting on healthcare resources. Although there is a commonality of approach to clinical practice in Europe, aided by the publication of European guidelines, the implementation of these is hindered by the need to overcome national obstacles, particularly for new indications for established therapies and for innovative therapies. Cost efficacy assessments and evidence-based medicine are blurred and used as rationing tools. National inequalities and disparate healthcare systems will become divisive in a European theatre that is otherwise seeing greater political and economic integration. There needs to be a mature and honest debate on how to bring the benefits of implantable device medical technology to the patient population which will benefit.