Cost Analysis of the Extravascular Implantable Cardioverter-Defibrillator Compared to the Subcutaneous System in Patients at Risk of Sudden Cardiac Death in Italy
Author(s)
Francesca Borghetti, MSc1, Reece Holbrook, BS, MBA2, Gaia Maria Luna Maglionico, MSc3, MARA CORBO, Eng.4, Francesca Mariani, MSc1.
1Medtronic Italia SpA, Milano, Italy, 2Medtronic, Mounds View, MN, USA, 3Medtronic Italia, Milan, Italy, 4Medtronic Italia Spa, Milano, Italy.
1Medtronic Italia SpA, Milano, Italy, 2Medtronic, Mounds View, MN, USA, 3Medtronic Italia, Milan, Italy, 4Medtronic Italia Spa, Milano, Italy.
OBJECTIVES: The extravascular implantable cardioverter-defibrillator (EV-ICD) for the prevention of sudden cardiac death (SCD) offers several advantages compared to traditional implantable defibrillators. Additionally, the longer expected battery life of the EV-ICD, compared to the subcutaneous device (S-ICD), reduces the need for replacements and associated complications, contributing to lower healthcare resource utilization in the long term. The objective of this study is to estimate the economic impact of introducing the EV-ICD compared to the S-ICD from the perspective of the National Health System (NHS).
METHODS: A hypothetical cohort of 1,000 Italian patients was considered, with an average age of 52.5 years, and the risk of SCD for the cohort. A Markov model with four-month cycles was created for the simulation. Demographic and clinical data were derived from the literature. Technical data provided by manufacturers were used for device longevity (11.7 years for EV-ICD and 7.3 years for S-ICD). Implantation, replacement, complication, and follow-up costs were calculated based on DRG tariffs and outpatient tariffs. An annual discount rate of 3% was applied. A sensitivity analysis was conducted to ensure the robustness of the results.
RESULTS: A reduction of 1.5 replacements (1.9 vs 3.4) per patient over the time horizon has been observed for the EV-ICD. The related savings are €20,277 vs S-ICD (€68,543 vs. €48,267). For younger patients, the savings increased, as a consequence of their longer survival / reduced need for replacements. Sensitivity analyses confirmed the robustness of the results.
CONCLUSIONS: The use of the EV-ICD for the prevention of SCD could significantly reduce long-term healthcare costs in eligible patients faced with the S-ICD, thanks to the decreased number of replacements and complications. Additional data will be needed to confirm this hypothesis, but the results show that the value of innovation must be assessed by considering the patient's journey beyond the simple upfront costs.
METHODS: A hypothetical cohort of 1,000 Italian patients was considered, with an average age of 52.5 years, and the risk of SCD for the cohort. A Markov model with four-month cycles was created for the simulation. Demographic and clinical data were derived from the literature. Technical data provided by manufacturers were used for device longevity (11.7 years for EV-ICD and 7.3 years for S-ICD). Implantation, replacement, complication, and follow-up costs were calculated based on DRG tariffs and outpatient tariffs. An annual discount rate of 3% was applied. A sensitivity analysis was conducted to ensure the robustness of the results.
RESULTS: A reduction of 1.5 replacements (1.9 vs 3.4) per patient over the time horizon has been observed for the EV-ICD. The related savings are €20,277 vs S-ICD (€68,543 vs. €48,267). For younger patients, the savings increased, as a consequence of their longer survival / reduced need for replacements. Sensitivity analyses confirmed the robustness of the results.
CONCLUSIONS: The use of the EV-ICD for the prevention of SCD could significantly reduce long-term healthcare costs in eligible patients faced with the S-ICD, thanks to the decreased number of replacements and complications. Additional data will be needed to confirm this hypothesis, but the results show that the value of innovation must be assessed by considering the patient's journey beyond the simple upfront costs.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
MT11
Topic
Economic Evaluation, Health Technology Assessment, Medical Technologies
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas