Abstract
Atrial fibrillation (AF) is a relevant comorbidity in recipients of implantable cardioverter-defibrillators (ICD). Latest generation single-chamber ICD allow the additional sensing of atrial tachyarrhythmias and, therefore, contribute to the early detection and treatment of AF, potentially preventing AF-related stroke. The present study aimed to measure the impact on patient-related costs of this new ICD compared to conventional ICD. A Markov model was developed to simulate the long-term incidence of stroke in patients treated with a single-chamber ICD with or without atrial sensing capabilities. The median annual cost per patient and its difference, the number of strokes avoided, and the cost per stroke avoided were estimated. During a 9-year horizon, the costs for the ICD and stroke treatment were €570 per patient-year for an ICD with atrial sensing capabilities and €491 per patient-year for a conventional ICD. Per 1,000 patients, 4.6 strokes per year are assumed to be avoided by the new device. Higher CHA2DS2-VASc scores are associated with higher numbers of avoided strokes and larger potential for cost savings. Apart from clinical advantages, the use of ICD with atrial sensing capabilities may reduce the incidence of stroke and, in high-risk patients, may also contribute to reduce overall health care costs.
Highlights
Implantable cardioverter-defibrillators (ICD) are indicated for the primary and secondary prevention of sudden cardiac death
Assuming new oral anticoagulant (NOAC) are slightly more effective in reducing strokes than Warfarin [20], we considered a stroke risk reduction of 66% for Rivaroxaban compared to untreated Atrial fibrillation (AF) patients
Not considering the hospitalization costs related to the initial implantable cardioverter-defibrillators (ICD) implantation, the mean patient-related costs during the first year were €337 for patients receiving the Lumax VR-T DX system compared to €295 for patients receiving the conventional ICD
Summary
Implantable cardioverter-defibrillators (ICD) are indicated for the primary and secondary prevention of sudden cardiac death. Due to the missing atrial lead, conventional singlechamber ICD cannot provide atrial intracardiac electrograms (IEGM) as well as direct information about the atrial rate This missing functionality is a significant limitation for the reliable detection of atrial tachyarrhythmias (ATs) including atrial fibrillation (AF). A major indication (Class I) for an ICD implantation according to current ESC Guidelines is, e.g., the recommendation to reduce sudden cardiac death in patients with symptomatic heart failure (NYHA class IIIII) and left ventricular ejection fraction ≤ 35% [2]. This recommendation includes patient subgroups with or without ischemic aetiology
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