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Abstract 326: Healthcare Costs for Cardiac Implantable Electronic Device (CIED) Revision Procedures From 2004-2012
Journal article

Abstract 326: Healthcare Costs for Cardiac Implantable Electronic Device (CIED) Revision Procedures From 2004-2012

Jasmine D Patel, Jordana Schmier, Edmund Lau, Steven M Kurtz and Arnold Greenspon
Circulation Cardiovascular quality and outcomes, v 8(suppl_2)
May 2015
DOI: https://doi.org/10.1161/circoutcomes.8.suppl_2.326

Abstract

Introduction: The healthcare costs and clinical outcomes for Medicare beneficiaries undergoing revision procedures for CIED (ICD and CRT-D) were evaluated. Methods: The Medicare cohort for this study was defined by the following criteria: (a) ≥ 65 years old (b) implanted with a primary ICD/CRT-D in 2004 or 2005, (c) survived through 2012 and (c) underwent their 1st revision for a generator replacement (ERI) only. Patients were excluded if the procedures were associated with a recall, complication, or faulty lead. Total medical costs for the observation period, including subsequent revisions (≥ 2 revisions) and 6 month follow-up care due to complications, were identified from the reimbursement claim amounts. Costs were adjusted to 2014 US$. Results: Just over one thousand (ICD=605, CRT-D=408) t met the inclusion criteria.. This cohort of revised patients was composed primarily of men (~75%) and were between the ages of 65-74 years (>60%). Nineteen percent of patients had a Charlson Comorbidity Index score of 5 or higher, indicating substantial comorbidity. The total health care cost of these patients was approximately $185M, with just over half of the cost coming from ICD patients. Patients that had received only one revision over the eight year time period accounted for 92% of the population and cost on average $183K per patient over the study period. Patients who had undergone multiple generator replacement procedures accounted for 8% of the study cohort and cost on average $213K per patient over eight years. Preliminary cost analysis of complications associated with these revision procedures suggested that complications were also a significant financial burden. Conclusion: CIED revisions due to ERI are associated with a substantial clinical and financial burden. Minimizing the number of revisions will reduce the financial burden of CIED procedures. Evaluation of the costs for individual infection (sepsis, endocarditis etc.) and non-infection complications (cardiac perforation, hematoma etc.) is also underway.

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