Public procurement of cardiac implantable electronic devices across Europe: are we purchasing value or cost-effectiveness?
Year: 2026
Type: article
Abstract: AIMS: Procurement 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. OBJECTIVE: The 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 RESULTS: We 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. CONCLUSION: Cardiac 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.
Source: EP Europace
Authors: Lucía Osoro, Elena Arbelo, Nikola Kozhuharov, Runa Landen, Martin Martinek, Christophe Leclerq, Laurent Fauchier, Jean-Claude De Haro, Serge Boveda, Philipp Sommer, Michiel Rienstra, Piotr Szymański, Michal Farkowski, Anastasia Egorova, Francisco Moscoso Costa, Diana Tint, Stefan Simovic, Krasimir Dzhinsov, Francisco Leyva, Giuseppe Boriani, Josep Figueras, Zenichi Ihara, Jose Luis Merino, Haran Burri, Helmut Pürerfellner, Rubén Casado-Arroyo
Institutions: Université Libre de Bruxelles, Erasmus Hospital, HM Hospitales, Camilo José Cela University, Hospital Clínic de Barcelona, University Hospital of Bern, University of Gothenburg, Krankenhaus der Elisabethinen, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Centre Hospitalier Universitaire de Tours, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Hôpital de la Timone, Clinique Pasteur, Heart and Diabetes Center North Rhine-Westphalia, University Medical Center Groningen, University of Groningen, National Medical Institute of the Ministry of Interior and Administration, Ministry of Interior and Administration, Leiden University Medical Center, Hospital da Luz, Transylvania University of Brașov, University of Kragujevac, University Multipurpose Hospital for Active Treatment "Sveti Georgi", Aston University, Azienda Ospedaliero-Universitaria di Modena, European Observatory on Health Systems and Policies, Hospital Universitario La Paz, University Hospital of Geneva
Language: English
Subfield: Strategy and Management
Domain: Social Sciences
Open Access status: hybrid
Estimated APC paid: $4,909
Funders: Boehringer Ingelheim, Pfizer, Bayer, Sanofi, Medtronic, iRhythm Technologies, Freiwillige Akademische Gesellschaft, ZOLL Medical Corporation, Boston Scientific Japan, Dutch Cardiovascular Alliance, British Microcirculation Society, European Commission, European Society of Cardiology, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, ZonMw, Daiichi-Sankyo, Hartstichting, Gottfried und Julia Bangerter-Rhyner-Stiftung, MicroPort, Janssen Biotech, City of Boston
Awards: G232572082, G4652779849, Derivation and External Validation of a Predictive Score for Right Ventricular Pacing Induced Cardiomyopathy Following AV Node Ablation, Heart Failure Outcomes in the Left Atrial Arrhythmia Substrate identification by Ultra High-Density Mapping after confirmed durABLE PV isolation - A randomised controlled pilot study.
OpenAlex ID: W7130316409