Public procurement of cardiac implantable electronic devices across Europe: are we purchasing value or cost-effectiveness?
Publisher DOI
PubMed ID
41709087
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.
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.
Date Issued
2026-02-03
Publication Type
Article
Subject(s)
Subjects
Cardiac implantable devices
•
EU health systems
•
Health economics
•
Pacemakers
•
Public procurement
•
Reimbursement
•
Value-based healthcare
Language(s)
en
Author(s)
Osoro, Lucía | |
Arbelo, Elena | |
Landen, Runa | |
Martinek, Martin | |
Leclerq, Christophe | |
Fauchier, Laurent | |
De Haro, Jean-Claude | |
Boveda, Serge | |
Sommer, Philipp | |
Rienstra, Michiel | |
Symanski, Piotr | |
Farkowski, Michal | |
Egorova, Anastasia | |
Moscoso Costa, Francisco | |
Tint, Diana | |
Simovic, Stefan | |
Dzhinsov, Krasimir | |
Leyva, Francisco | |
Boriani, Giuseppe | |
Figueras, Josep | |
Ihara, Zenichi | |
Merino, Jose Luis | |
Burri, Haran | |
Pürerfellner, Helmut | |
Casado-Arroyo, Rubén |
Additional Credits
Journal
EP Europace
Publisher
Oxford University Press
ISSN
1532-2092
1099-5129
Access(Rights)
open.access