Cost-effectiveness of cardioverter-defibrillators in heart failure patients.

Cowie et al. 1 present a cost-effectiveness analysis of prophylactic implantation of implantable cardioverter-defibrillators (ICDs) in patients with mild-to-moderate heart failure (NYHA class II and III) and reduced left ventricular ejection fraction (LVEF). The analysis adopts the perspective of the Belgian health care system. The authors show that the incremental cost-effectiveness ratio (ICER) of ICD implantation is €29 530 per quality-adjusted life year gained (QALY) and conclude that ICD implantation ‘represents good value for money'. Although the evaluation is, in some regards, quite elaborate (e.g. considers the various complications of ICD implantation), I am concerned that the assumptions are too favourable …