The economic impact of battery longevity in implantable cardioverter-defibrillators for cardiac resynchronization therapy: the hospital and healthcare system perspectives

• Published in: Europace (London, England) England), 2017-08, Vol.19 (8), p.1349-1356
• Main Authors: Landolina, Maurizio, Morani, Giovanni, Curnis, Antonio, Vado, Antonello, D'Onofrio, Antonio, Bianchi, Valter, Stabile, Giuseppe, Crosato, Martino, Petracci, Barbara, Ceriotti, Carlo, Bontempi, Luca, Morosato, Martina, Ballari, Gian Paolo, Gasparini, Maurizio
• Format: Article
• Language: English
• Subjects: Cardiac Resynchronization Therapy - economics; Cardiac Resynchronization Therapy Devices - economics; Clinical Research; Cost Savings; Cost-Benefit Analysis; Databases, Factual; Defibrillators, Implantable - economics; Device Removal - economics; Electric Countershock - adverse effects; Electric Countershock - economics; Electric Countershock - instrumentation; Electric Power Supplies - economics; Equipment Design; Equipment Failure; Health Care Costs; Health Expenditures; Heart Failure - diagnosis; Heart Failure - economics; Heart Failure - therapy; Humans; Italy; Models, Economic; Time Factors
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euw176

Patients receiving cardiac resynchronization therapy defibrillators (CRT-Ds) are likely to undergo one or more device replacements, mainly for battery depletion. We assessed the economic impact of battery depletion on the overall cost of CRT-D treatment from the perspectives of the healthcare system and the hospital. We also compared devices of different generations and from different manufacturers in terms of therapy cost. We analysed data on 1792 CRT-Ds implanted in 1399 patients in 9 Italian centres. We calculated the replacement probability and the total therapy cost over 6 years, stratified by device generation and manufacturer. Public tariffs from diagnosis-related groups were used together with device prices and hospitalization costs. Generators were from 3 manufacturers: Boston Scientific (667, 37%), Medtronic (973, 54%), and St Jude Medical (152, 9%). The replacement probability at 6 years was 83 and 68% for earlier- and recent-generation devices, respectively. The need for replacement increased total therapy costs by more than 50% over the initial implantation cost for hospitals and by more than 30% for healthcare system. The improved longevity of recent-generation CRT-Ds reduced the therapy cost by ∼6% in both perspectives. Among recent-generation CRT-Ds, the replacement probability of devices from different manufacturers ranged from 12 to 70%. Consequently, the maximum difference in therapy cost between manufacturers was 40% for hospitals and 19% for the healthcare system. Differences in CRT-D longevity strongly affect the overall therapy cost. While the use of recent-generation devices has reduced the cost, significant differences exist among currently available systems.