The Emerging Role of Intracardiac Echocardiography -- Into the ICE Age

Andrew R.J. Mitchell; Prasanna Puwanarajah; Jonathan Timperley; Harald Becher; Neil Wilson; Oliver J. Ormerod

Disclosures

Br J Cardiol. 2007;14(1):31-36. 

In This Article

Overcoming Cost

Unfortunately, ICE catheters are currently single-use devices that cost approximately £1,600 in the United Kingdom. As ICE can be performed under local anaesthesia, however, the costs of the anaesthetist, anaesthetist's assistant and anaesthetic drugs can be saved. In addition, the use of local anaesthetic enables the procedure to be performed as a day case saving the cost of an overnight stay. If the interventional cardiologist performing ASD closure can also perform the ICE imaging, this saves the cost of an additional echocardiographer and TOE equipment.

Using this model, an analysis has been carried out in the USA on the costs incurred for 38 patients using ICE and TOE for imaging ASD closure.[26] The authors concluded that overall costs for the procedures were similar when using ICE and TOE (US$ 33,563 vs. US$ 32,812, respectively, p=0.4). In the NHS, however, physician charges and costs for echocardiography procedures are not so clearly demarcated. Nevertheless, in Oxford we have identified that the cost difference between ICE and TOE is marginal and with "payment by results", the additional time saved by performing the procedure under ICE may allow revenue to be generated by performing an additional catheter laboratory procedure. Our current practice, therefore, is to routinely offer the patient ASD and PFO closure under ICE guidance, providing that the primary care trust agree.

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