SCD-HeFT

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Economics and Reimbursement for ICDs

Cost of ICDs
CMS Expands Coverage for ICDs

Cost Effectiveness of ICD Therapy in SCD-HeFT

The preliminary results of the Cost Effectiveness of ICD Therapy in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) were presented at the American Heart Association (AHA) Scientific Session 2004. To view the presentation and webcast visit www.scientificsessions.org and follow the steps below:

  • Click 'Science for Everyday'
  • Select 'Presentation Webcasts'
  • Sign in
  • Select 'LBCT IV Webcast - View Presentations'
  • Select 'SCD-HeFT'

Cost of Treatment with an ICD

Research shows that ICDs provide an invaluable form of life insurance for people most at risk, preventing SCA death 98% of the time.13 Evidence-based medicine has demonstrated that ICDs significantly reduce death among Americans at highest risk:

  • 31% reduction in death among SCA survivors from a second event.14
  • 31% reduction in death among post-heart attack sufferers.15

Despite these statistics, ICDs are underutilized.

  • Fewer than 20% of currently indicated patients receive the benefits of an ICD despite being at high risk for sudden death.
  • Although SCA is responsible for more deaths than breast cancer, lung cancer, stroke and HIV/AIDS combined, spending on SCA prevention is modest when compared to other diseases.
    • AIDS: $19.5 billion, stroke $6 billion, lung cancer $1.6 billion, breast cancer: $0.8 billion.16
    • SCA: $2.4 billion (including drug and device therapy).17

View and print The New England Journal of Medicine article online


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The value of ICDs outweighs their cost to the system.

  • An ICD costs approximately $25,000 (including implant costs), which equates to less than $10 per day over the average life of a device (seven years).18,19
  • The cost per day of ICD protection has decreased by nearly 90% over the last 10 years from more than $90 in 1990 to less than $10 today (equivalent to the cost of optimal medical therapy for these same patients).19
  • ICD Medicare expenditures are significantly less than for other cardiovascular procedures. In 2002, Medicare reimbursed $1.2 billion for ICD procedures vs. $6.4 billion for stent implants and $7.8 billion for bypass surgery.17
  • The cost of ICD therapy per year is less than 0.2% of projected Medicare spending over the next 10 years.20

12Cummins RO. From concept to standard-of-care? Review of the clinical experience with automated external defibrillators. Annals of Emergency Medicine 1989,18: 1269-75.

13Zipes, Douglas. Arrhythmias/Defibrillators: Results of the International Study of the Implantable Pacemaker Cardioverter-Defibrillator: A Comparison of Epicardial and Endocardial Lead Systems. Circulation. 1995;92:59-65.

14The AVID Investigators. Antiarrhythmics Versus Implantable Defibrillators (AVID)-Rationale, Design, and Methods. Am J Cardiol. 1995;75:470-475.

15Moss AJ, Zareba W, Hall WJ, et al., for the Multicenter Automatic Defibrillator Implantation Trial II Investigators, Prophylactic Implantation of a Defibrillator in Patients with Myocardial Infraction and Reduced Ejection Fraction. N Engl J Med. 2002;346:877-83.

16Calculated from Healthcare Financing Review, Medicare and Medicaid Statistical Supplement, 2001 (Expenditures updated to 2002 $US with the medical component of the CPI).

17Calculated from an analysis of the 2002 MedPAR data set and Healthcare Financing Review, Medicare and Medicaid Statistical Supplement, 2001 (Expenditures updated to 2002 $US with the medical component of the CPI).

18Extrapolated by Medtronic from Olshansky, Brian. Implantable Cardioverter-Defibrillator practices and costs at an academic medical center. J Cardiovascular Electrophysiol, 2002;12:162-166.

19Steinhaus D, Cardinal D, Connelly DT, et al. Cost savings with nonthoracotomy implantable cardioverter defibrillators, Am J Cardiol. 1996; 78:1255-1259.

20IMS America 2001 Pharmaceutical sales figures as viewed at:www.cms.hhs.govt/statistics/nhe/historical/t2asp.