Guidance

4 NHS considerations

4 NHS considerations

System impact

4.1

The company claimed that fewer avoidable replacement procedures will lead to a reduction in hospital admissions, bed days and procurement costs. Fewer replacement procedures could result in more efficient use of resources, because it would allow more primary (that is, non‑replacement) implants within the same resource constraints. The company also claimed that using ENDURALIFE‑powered cardiac resynchronisation therapy-defibrillator (CRT‑D) devices could lead to cost savings through a reduction in associated costs such as post-operative complications and infections resulting from replacement procedures.

Committee considerations

4.2

The committee was advised by clinical experts that although replacements are done for a variety of reasons, including lead failures, 80% to 90% of CRT‑D replacements are because of battery depletion.

4.3

The committee heard from experts that the cost of replacing a CRT‑D is between £10,000 and £15,000, not including the cost of additional leads.

4.4

The committee was advised that remote monitoring affects battery drain across all manufacturers' devices to a variable degree.

4.5

The committee heard from experts that, despite increased battery life being an important patient benefit, it is standard practice for a single centre to use CRT‑Ds from more than 1 manufacturer. The rationale is to spread the risk of undue pressure on clinical services in the face of possible future device-related technical failure necessitating recall and replacement. In view of this important consideration, professional advice was that it was unwise for a department to rely entirely on the use of a CRT‑D from a single manufacturer.