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

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.