002 IMPLANTABLE CARDIOVERTER DEFIBRILLATOR THERAPY OR CARDIAC RESYNCHRONISATION THERAPY WITH DEFIBRILLATION IN PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION: A COST-IMPACT STUDY

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 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.