Cost-effectiveness of implantable cardioverter-defibrillators

Arrhythmic death is the most frequent cause of sudden cardiac death in the adult population, even today; in the United States its incidence is 300–400 000 cases per year. The pathophysiological substrate of sudden cardiac death is coronary artery disease in more than 90% of cases, and in more than 75% a previous myocardial infarction is present at clinical history. In spite of a reduction in coronary artery disease-related mortality in recent years, today the number of sudden cardiac deaths is nearly the same as in the past and accounts for about 50% of deaths. The implantable cardioverter-defibrillator is the most effective tool to treat malignant ventricular tachyarrhythmias and a series of controlled studies are evaluating the capability of the implantable cardioverterdefibrillator to reduce total mortality in selected patients at high risk of sudden cardiac death. In recent years, a striking technological evolution has led to important consequences on the modality of the implantable cardioverter-defibrillator implant, on the implantable cardioverter-defibrillator-related hospital stay and, in general, on implantable cardioverter-defibrillator costs (Table 1). The possibility of implanting an implantable cardioverterdefibrillator in the electrophysiological laboratory, with minimal risks for patients, has meant that the implantable cardioverter-defibrillator is considered the best therapeutic strategy in the prevention of arrhythmic death in selected patients at high risk of sudden cardiac death.