Background Increasing evidence from clinical outcomes studies suggest that cardiac resynchronisation therapy with defibrillation (CRT-D) is superior to implantable cardioverter defibrillator (ICD) therapy alone in patients with left ventricular dysfunction.
Methods We undertook a retrospective analysis of all ICD and CRT-D implants from April 2006 to July 2012. Cost data was obtained on an individual patient basis, derived from financial records of transactions between payers and the provider.
Results A total of 921 patients (aged 63±14 years (mean±SD), 49 (91%) male) underwent device implantation: 486 (53%) de novo CRT-D; 381 (41%) single/dual chamber ICD; and, 54 (6%) upgrade from ICD to CRT-D. In the upgrades from ICD to CRT-D, the median time from ICD to CRT-D implantation was 3.2 years. From the time prior to ICD implantation to prior to CRT-D, the LVEF decreased from 30±9.4% to 22±8.7% (p<0.001), the QRS duration increased from 133±34.9 ms to 158±29.3 ms (p=0.0003) and all patients had progressed to NYHA class III. In this upgrade group, the initial ICD implantation cost £846 864 (34 electives: £511 904; 20 non-electives: £334 960) and the upgrade to CRT-D cost £1 330 614 (44 electives: £1 046 364; 10 non-electives: £284 250), totalling £2 177 478 in implantation costs alone over a median of 3.2 years. If these 54 patients had a CRT-D at the initial implant, it would have cost £1 377 054 (34 electives: £808 554; 20 non-electives: £568 500). Therefore, this approach would have saved £800 424 in implantation costs alone.
Conclusions This study indicates that upgrading from ICD to CRT-D is costly. Our findings suggest that implantation of CRT-D in patients with known left ventricular dysfunction may be more cost-effective.