Cost-minimization analysis of a wearable cardioverter defibrillator in adult patients undergoing ICD explant procedures: Clinical and economic implications.
AIMS
Patients with permanently increased risk of sudden cardiac death (SCD) can be protected by implantable cardioverter defibrillators (ICD). If an ICD must be removed due to infection, for example, immediate reimplantation might not be possible or indicated. The wearable cardioverter defibrillator (WCD) is an established, safe and effective solution to protect patients from SCD during this high-risk bridging period. Very few economic evaluations on WCD use are currently available.


METHODS
We conducted a systematic review to evaluate the available evidence of WCD in patients undergoing ICD explant/lead extraction. Additionally, a decision model was developed to compare use and costs of the WCD with standard therapy (in-hospital stay). For this purpose, a cost-minimization analysis was conducted, and complemented by a one-way sensitivity analysis.


RESULTS
In the base case scenario, the WCD was less expensive compared to standard therapy. The cost-minimization analysis showed a cost reduction of €1782 per patient using the WCD. If costs of standard care were changed, cost savings associated with the WCD varied from €3500 to €0, assuming costs for standard care of €6800 to €3600.


CONCLUSION
After ICD explantation, patients can be safely and effectively protected from SCD after hospital discharge through WCD utilization. Furthermore, the use of a WCD for this patient group is cost saving when compared to standard therapy.
['Boriani|Giuseppe|G|https://orcid.org/0000-0002-9820-4815', 'Mantovani|Lorenzo Giovanni|LG|https://orcid.org/0000-0003-3866-8199', 'Cortesi|Paolo Angelo|PA|https://orcid.org/0000-0002-5353-3957', 'De Ponti|Roberto|R|https://orcid.org/0000-0003-3278-1721', "D'Onofrio|Antonio|A|", 'Arena|Giuseppe|G|https://orcid.org/0000-0002-0266-6493', 'Curnis|Antonio|A|', 'Forleo|Giovanni|G|https://orcid.org/0000-0001-8895-8915', 'Guerra|Federico|F|https://orcid.org/0000-0001-5394-1312', 'Porcu|Maurizio|M|https://orcid.org/0000-0003-0633-1487', 'Sgarito|Giuseppe|G|', 'Botto|Giovanni Luca|GL|https://orcid.org/0000-0002-8049-7517']
D000328:Adult D003362:Cost-Benefit Analysis D016757:Death, Sudden, Cardiac D047548:Defibrillators D017147:Defibrillators, Implantable D004554:Electric Countershock D006801:Humans D000076251:Wearable Electronic Devices
cost-minimization analysis wearable cardioverter defibrillator ICD explant sudden cardiac death health technology assessment ventricular arrhythmia