University of Bologna.
Int J Technol Assess Health Care. 2011 Jul;27(3):201-6. doi: 10.1017/S0266462311000183.
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).
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).
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.
我们根据植入式心脏复律除颤器（ICD）的实际寿命计算了其每日成本，以证明前期成本是否是 ICD 购买过程的可靠参数。
测量了 2000 年、2001 年和 2002 年植入的所有患者中单腔（SC）、双腔（DC）和双心室（BiV）Medtronic（MDT）、Guidant（GDT）和 St. Jude Medical（SJM）ICD 的寿命，这些患者在 2009 年 12 月 31 日前达到了设备更换标准。每个 ICD（设备+导线/导联）的成本均与其自身寿命进行了归一化。数据表示为中位数（25-75 百分位数）。
共有 123/153 例患者完成了研究，70%的患者在植入 8 年后仍存活。MDT 设备的寿命明显优于 GDT 和 SJM（p <.001）。58%更换的 ICD 的使用寿命比制造商的预测至少短 1 年。寿命较长的设备的日成本显著降低：SC 为 €4.8（4.6-5.7）vs. €6.8（6.2-9.2）和 €6.9（6.2-7.6）（p <.001）；DC 为 €6.9（6.8-7.7）vs. €12.6（11.8-13.3）和 €13.4（10.3-16.1）（p <.005）；BiV 为 €8.5（8.3-10.3）vs. €15.4（15.1-15.8）和 €14.6（14.1-14.9）（p <.005）。
ICD 治疗的实际成本严格取决于设备寿命，而设备前期成本则不可靠。这一方面应在技术采购过程中加以重视，并为基于结果的报销系统奠定基础。我们的观察结果可能分别成为未来比较中 ICD 寿命和每日 ICD 成本的基准。需要在实际场景中进行独立观察，以正确评估新技术的改进。
