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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.