Presentation (CTI)

OBJECTIVES: To estimate the 1-year budget impact and environmental consequences of adding a wearable cardioverter-defibrillator (WCD) to guideline-directed therapy (GDT) in France for two reimbursed populations: post-acute myocardial infarction (AMI) with ischemic heart failure and implantable cardioverter-defibrillator (ICD) explantation.
METHODS: An R/Shiny deterministic budget impact model compared WCD+GDT versus GDT over 1 year in the French health system. Only the two relevant cohorts were included. Model outputs incorporated intervention, initial hospitalisation, monitoring, adverse events, ICD implantation, ICD-related events, cardiac arrest, end-of-life, and CO2-related outcomes. Eligible populations were 19,930 patients for post-AMI/ischemic heart failure and 300 for ICD explantation. Outcomes were total costs, incremental budget impact, CO2 emissions, and monetized CO2 savings.
RESULTS: In post-AMI/ischemic heart failure, WCD+GDT increased total costs versus GDT (€836.9M vs €714.3M), corresponding to a budget impact of €122.5M. In ICD explantation, WCD+GDT reduced total costs (€10.4M vs €17.3M), generating savings of €6.8M. Across both cohorts, total costs were €847.3M with WCD+GDT and €731.6M with GDT, yielding a net budget impact of €115.7M. CO2 emissions were 51.4M kg with WCD+GDT and 63.9M kg with GDT, corresponding to 12.5M kg CO2 averted and €3.16M in monetized carbon savings. After incorporating carbon savings, the net budget impact was €112.6M.
CONCLUSIONS: In current French reimbursed WCD indications, the overall short-term budget impact is driven by the much larger post-AMI/ischemic heart failure population, whereas ICD explantation appears cost-saving. Incorporating environmental outcomes shows a substantial reduction in emissions with WCD use, although these savings only partly offset the incremental spend driven by the post-AMI cohort.