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. 2025 Apr 23;26(4):36206.
doi: 10.31083/RCM36206. eCollection 2025 Apr.

Economic Evaluations in Electrophysiology in the Last 15 Years: A Systematic Review of the Literature

Davide Antonio Mei  1   2   3 , Jacopo Francesco Imberti  1 , Marco Vitolo  1 , Niccolò Bonini  1 , Edoardo Casali  1 , Lucia Osoro  3   4 , Ruben Casado-Arroyo  3   4 , Giuseppe Boriani  1
Affiliations

Economic Evaluations in Electrophysiology in the Last 15 Years: A Systematic Review of the Literature

Davide Antonio Mei et al. Rev Cardiovasc Med. .

Abstract

Background: Electrophysiology (EP) procedures, including cardiac implantable electronic devices (CIEDs) and ablations, are widely used to manage arrhythmias and heart failure. These interventions, though effective, require substantial resources, prompting the need for systematic economic evaluations to inform healthcare decision-making.

Methods: A systematic review of studies from 2007 to 2024 was conducted in two phases. Phase one assessed trends in economic evaluations of EP procedures, analyzing 129 studies across regions and timeframes. Phase two focused on cost-effectiveness analyses of implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy defibrillators (CRT-Ds), and atrial fibrillation (AF) ablation, examining outcomes like quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs), while identifying factors influencing economic results.

Results: EP procedures generally demonstrated favorable cost-effectiveness, particularly in high-income regions. Studies on ICDs and CRT-Ds consistently supported their economic value for patients with arrhythmias or heart failure, while AF ablation showed potential for long-term benefits, particularly when compared to medical therapies. However, results varied by region, reflecting differences in healthcare systems, costs, and patient populations.

Conclusions: The review highlights the overall cost-effectiveness of EP procedures in many settings but underscores the need for tailored economic evaluations in low- and middle-income countries. Simplified methodologies and greater attention to regional contexts are recommended to guide resource allocation and policy development globally.

Keywords: ablation; atrial fibrillation; cost-effectiveness; defibrillator; health economics; pacemaker.

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Conflict of interest statement

The authors declare no conflict of interest. GB reported small speaker fees from Bayer, Boehringer Ingelheim, Boston, Daiichi Sankyo, Janssen, and Sanofi outside of the submitted work. GB is also the Principal Investigator of the ARISTOTELES project (Applying ARtificial Intelligence to define clinical trajectorieS for personalized predicTiOn and early deTEction of comorbidity and muLtimorbidity pattErnS), funded by the European Union within the Horizon 2020 research and innovation program (Grant No. 101080189). LO received funding from the European Union for collaboration in the ASSESS DHT project (grant number 101137347) and has received speaker fees for a consulting contract with Eli Lilly and Company. RCA has received small honoraria for educational meetings from Abbott and Boston Scientific. All other authors report no disclosures. Ruben Casado-Arroyo and Giuseppe Boriani are serving as the Editorial Board members of this journal. We declare that Ruben Casado-Arroyo and Giuseppe Boriani had no involvement in the peer review of this article and have no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Yong Peng.

Figures

Fig. 1.
Fig. 1.
PRISMA Flow-Chart of the Study. Incl/Exc, inclusion/exclusion.
Fig. 2.
Fig. 2.
Distributions of economic studies according to category of electrophysiological procedures. EP, electrophysiology; CIED, cardiac implantable electronic device; ICD, implantable cardioverter defibrillator; CRT-D, cardiac resynchronization therapy with defibrillator; CRT-P, cardiac resynchronization therapy with pacemaker; AF, atrial fibrillation; PM, pacemaker; WCD, wearable cardiac defibrillator; PSVT, paroxysmal supraventricular tachycardia; VT, ventricular tachycardia; S-ICD, subcutaneous implantable cardiac defibrillator.
Fig. 3.
Fig. 3.
Distributions of economic studies according to geographical setting.
Fig. 4.
Fig. 4.
Temporal trends of procedures related to electrophysiological procedures.
See this image and copyright information in PMC

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