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Heart Failure Congress 2009 Presentation
01 Jun 2009

Health economics for the clinician - what do we need to know? 

Webcasts available

Martin R. Cowie 

Martin R. Cowie
Topics: Heart Failure (HF)
Session number: 1036
Session title: Can you afford not to implant devices?
Authors: Cowie, Martin R. (London, GB)

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Much attention is focused on the 'up front' costs of device therapy - with a perception of this being expensive and therefore a luxury item. This lecture will explain how health economists view the issue of determining value for money, and how their calculations help inform an intelligent discussion of priorities for health care systems.

For wealthy countries in Europe, device therapy for heart failure is cost-effective compared with many other interventions, and is something that the health systems/insurance companies should cover - provided the clinical evidence for benefit is secure for the patient group being given this treatment, and such therapy is offered on top of good lifestyle management, drug therapy and monitoring.

CRT-P is highly cost-effective, and the initially more-expensive CRT-D therapy although less cost-effective than CRT-P still represents good health care benefit for the cost. Age of the patient, device cost, and battery longevity all affect cost-effectiveness.

Clinicians should become comfortable with discussing these issues - as they are considered key in health care decision making in the modern world.

Teaching objective of the lecture:

  • To explain the principles behind health economics, as relevant to a clinical audience
  • To use examples to explain how value for money is determined for interventions in heart failure
  • To explore some of the assumptions behind cost-effectiveness calculations
  • To reassure the audience that devices for heart failure (CRT-P, CRT-D) are good use for money in wealthy countries, if applied to the correct populations and on top of optimal drug therapy

Take home messages:

  • The principles of health economics are straightforward, and help to inform discussion on priorities for health care systems, In general more cost-effective measures should be applied first - such as optimising drug therapy in heart failure
  • Cardiac resynchronisation therapy is highly cost-effective as well as clinically effective
  • Implantable cardioverter defibrillator therapy is likely to be cost-effective if applied to the populations for which this device is recommended in the current ESC guidelines


The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.