Evidence map›Paper›PMID 41709087›Full record

ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2026

Public procurement of cardiac implantable electronic devices across Europe: are we purchasing value or cost-effectiveness?

Lucía Osoro, Elena Arbelo, Nikola Kozhuharov, Runa Landen, Martin Martinek, Christophe Leclerq, Laurent Fauchier, Jean-Claude De Haro, Serge Boveda, Philipp Sommer and 16 more

Erratum issuedAbstract read
In one paragraph

Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

26 authors.

Lucía OsoroDepartment of Cardiology, H.U.B.-Hôpital Erasme, Université Libre de Bruxelles, Brussels 1070, Belgium.ORCID 0009-0006-0787-7237
Elena ArbeloEHRA Advocacy, Quality Improvement, and Health Economics Committee (European Heart Rhythm Association), Sophia Antipolis, France.ORCID 0000-0003-0424-6393
Nikola KozhuharovEHRA Advocacy, Quality Improvement, and Health Economics Committee (European Heart Rhythm Association), Sophia Antipolis, France.ORCID 0000-0003-2086-3690
Runa LandenEHRA Advocacy, Quality Improvement, and Health Economics Committee (European Heart Rhythm Association), Sophia Antipolis, France.ORCID 0000-0002-2868-3582
Martin MartinekDepartment of Cardiology, Ordensklinikum Linz Elisabethinen, Linz, Austria.ORCID 0000-0002-8895-8488
Christophe LeclerqDepartment of Cardiology, CHU Rennes-Hôpital Pontchaillou, Rennes, France.ORCID 0000-0002-4399-5568
Laurent FauchierDepartment of Cardiology, Hôpital Trousseau, CHRU de Tours, Tours, France.ORCID 0000-0002-9267-1658
Jean-Claude De HaroAssistance Publique - Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France.ORCID 0000-0002-1534-3845
Serge BovedaCardiac Arrhythmia Department, Clinique Pasteur, Toulouse, France.ORCID 0000-0002-1280-7042
Philipp SommerHeart and Diabetes Center North Rhine-Westphalia, University Clinic of Bochum, Bad Oeynhausen, Germany.ORCID 0000-0002-3037-8704
Michiel RienstraUniversity of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.ORCID 0000-0002-2581-070X
Piotr SymanskiClinical Cardiology Department, National Institute of Medicine MSWiA, Warszawa, Poland.ORCID 0000-0001-9486-7892
Michal FarkowskiArrhythmia Unit, Ministry of Interior and Administration National Medical Institute, Warsaw, Poland.ORCID 0000-0003-1673-7712
Anastasia EgorovaCardiology Department, Leiden University Medical Center, Leiden, The Netherlands.ORCID 0000-0001-9312-2338
Francisco Moscoso CostaCardiology Department, Hospital da Luz, SA, Lisbon, Portugal.ORCID 0000-0003-4019-5618
Diana TintFaculty of Medicine, Transilvania University of Brasov, Brasov, Romania.
Stefan SimovicFaculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.ORCID 0000-0003-0911-2028
Krasimir DzhinsovElectrophysiology Unit, University Hospital 'Sveti Georgi', Plovdiv, Bulgaria.ORCID 0000-0002-4369-4255
Francisco LeyvaMedical Research Department, Aston University, Birmingham, United Kingdom of Great Britain & Northern Ireland.ORCID 0000-0002-2176-0223
Giuseppe BorianiDepartment of Cardiology, Policlinico di Modena, Italy.ORCID 0000-0002-9820-4815
Josep FiguerasEuropean Health Observatory on Health Systems and Policies, Brussels, Belgium.ORCID 0009-0000-9576-3067
Zenichi IharaHealth Economics and Reimbursement, Abbott, Zaventem, Belgium.ORCID 0000-0003-0613-0263
Jose Luis MerinoCardiac Robotic Unit, La Paz University Hospital, Madrid, Spain.ORCID 0000-0002-1737-1903
Haran BurriCardiology Department, University Hospital of Geneva, Geneva, Switzerland.ORCID 0000-0002-4393-5338
Helmut PürerfellnerInstitute of Medicine-Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.ORCID 0000-0002-8965-8495
Rubén Casado-ArroyoDepartment of Cardiology, H.U.B.-Hôpital Erasme, Université Libre de Bruxelles, Brussels 1070, Belgium.ORCID 0000-0002-3876-6074

Funding

ARISTOTELES 101080189ASSESS DHT 101137347BayerBMSBoehringer IngelheimBostonBoston ScientificDaiichi-SankyoDutch CardioVascular Alliance 01-002-2022-0118Dutch Heart FoundationEuropean Society of CardiologyEuropean UnionEuropean Union's Horizon 2020 research and innovation programme 945260Freiwillige Akademische GesellschaftGottfried und Julia Bangerter-Rhyner-StiftungiRhythmJanssenL. & Th. La Roche StiftungMedtronicMicroportNetherlands Cardiovascular Research Initiative CVON 2014-9Netherlands Cardiovascular Research Initiative CVON2017-11Netherlands Cardiovascular Research Initiative CVON-AI (2018B017)PfizerSanofiScientificSwiss National Science Foundation P400PM-194477Swiss National Science Foundation P5R5PM_210856Swiss Secretary for Education, Research and InnovationZollZonMw 848090001
6 · The paper itself

Abstract

aimsProcurement of cardiac implantable electronic devices (CIEDs) across the European Union is shaped by diverse healthcare systems, reimbursement mechanisms and levels of clinician involvement. Despite a shared legal framework, limited comparative data are available on how procurement is implemented across countries.

objectiveThe objectives of this study are to examine CIED procurement strategies in 22 European countries where public tendering is mandatory and to explore how clinical, economic and structural factors influence procurement processes. METHODS AND

resultsWe conducted 23 structured interviews with cardiologists and one industry expert across 22 European countries. A thematic analysis was used to synthesize procurement models, clinical involvement and reimbursement structures. No formal outcome or cost-effectiveness analysis was performed. Procurement models varied widely, encompassing centralized, decentralized and hybrid systems. Clinician involvement ranged from leading device selection based on clinical criteria to being excluded from decision-making in systems driven primarily by price. Reimbursement pathways also differed, with procedure tariffs for single-chamber pacemakers ranging from €1059 to €14 889. A single region in Finland had implemented a pilot value-based procurement model linking payment to patient outcomes.

conclusionCardiac implantable electronic device procurement across Europe is heterogeneous and predominantly cost driven, with limited integration of clinical outcomes or value-based principles. While not designed to evaluate cost-effectiveness directly, this study identifies procurement structures that may support or hinder value-based decision-making. Further research is needed to assess how procurement impacts clinical outcomes, innovation adoption and system sustainability.

Indexed as

Cardiac Resynchronization Therapy DevicesDefibrillators, ImplantableHealth Care CostsPacemaker, ArtificialValue-Based PurchasingCost-Benefit AnalysisCost-Effectiveness AnalysisEuropeHumansInsurance, Health, ReimbursementModels, EconomicReimbursement MechanismsValue-Based Health CareCardiac implantable devicesEU health systemsHealth economicsPacemakersPublic procurementReimbursementValue-based healthcare

Identifiers

PMID41709087
PMCPMC12916237

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.