Spotlight Issue "Electrophysiology and cardiac device therapy: why and how to approach health economics?" Volume 13 Supplement 2 May 2011 of EP Europace

This is a special issue of EP-Europace, with G Boriani as Guest Editor. It is the result of an initiative of the Committee on Health Economics and Outcome Research of EHRA, chaired by G Boriani. EHRA is the acronym of European Heart Rhythm Association, a branch of the European Society of Cardiology and it is the leader association on Electrophysiology and Arrhthmia science in Europe. This issue covers a wide spectrum of topics, starting from an overview of economic evaluations, and then focusing on the disease burden and emerging costs of atrial fibrillation and heart failure, two growing epidemics in western countries. The emerging role of European registries, a cornerstone of outcome research and policy making is also highlighted, as well as the important contribution of patient associations in promoting and supporting the access to evidence-based therapies. The applications of economic evaluations to a series of treatments that carry a high up-front cost, such as cardioverter defibrillators, devices for CRT, and atrial fibrillation ablation procedures are discussed in articles co-authored by both electrophysiologists and health economists. Remote monitoring, a new option for improving both patient care and the organization of device clinics, is also discussed. Finally, the application of health economics in policy making, the need for an appropriate approach to treatment with medical devices, taking into consideration the differences with pharmacological treatments, and the possibility to base decision making on a multidisciplinary approach, such as health technology assessment, are debated. In this complex scenario, the heterogeneity of reimbursement practices and the need for a refinement of DRG (diagnosis-related groups) systems and for new strategies to sustain and enhance those effective technological innovations that may be beneficial for specific patient populations are also highlighted. The issue includes 13 articles in 65 pages.