Economic impact of cardiac implantable electronic device infections: cost analysis at one year in a large U.S. health insurer

Abstract

Aims: Cardiac device infections (CDIs) are serious adverse events associated with morbidity and mortality, significant costs and increased healthcare utilization. The objective of the current study was to characterize the CDI rate by device type, risk factors for infection and healthcare costs from a large U.S. health insurer perspective. Materials and Methods: A retrospective analysis of a large U.S. health insurer database identified commercial and Medicare Advantage with Part D (MAPD) members !18 years with !1 claim for a cardiac implantable electronic device (CIED) procedure between 01 October 2011 and 31 October 2015. CIEDs included pacemakers (IPG), implantable cardioverter defibrillators (ICDs), and cardiac resynchronization therapypacemakers without (CRT-P) and with defibrillation (CRT-D). Probabilities of CDI through one-year post implant were estimated using the Kaplan-Meier method. A regression model with stepwise variable selection was used to select risk factors associated with CDIs. Results: A total of 63,406 patients were included with an overall CDI rate of 1.28% (1.0% de novo and 1.74% replacement devices), varying by device type: IPG ¼ 0.91%; ICD ¼ 1.63%; CRT-p ¼ 1.50%; CRT-D ¼ 2.22%. The average adjusted annual medical costs were 2.4 times greater [95% confidence interval (CI) ¼ 2.1-2.7] for those with an infection compared to those without, and the incremental cost difference was estimated to be $57,322 [95% CI $46,572-$70,484]. Observed risk factors of CDIs included prior device infection [Odds ratio (OR) ¼ 11.356; 95% CI ¼ 7.923-16.276], undergoing a CIED replacement procedure (OR ¼ 1.644; 95% CI ¼ 1.361-1.987), implantation of a high-power device (OR ¼ 1.354; 95% CI ¼ 1.115-1.643), and younger age (age < 65) (OR ¼ 1.607; 95% CI ¼ 1.307-1.976). Conclusions: The CDI rate at one year ranged from 0.91%-2.22% depending on device type. Management of CDIs among commercial and MAPD members is associated with high healthcare expenditures.

Cost-Effectiveness of an Antibacterial Envelope for Cardiac Implantable Electronic Device Infection Prevention in the US Healthcare System From the WRAP-IT Trial

“… 21 Infections are one of the most feared complications leading to substantial morbidity and 3-fold risk of mortality. 4 In spite of best practice, 1% to 4% of CIED procedures are associated with infection within 12 months, 6 , 22 – 25 and risk accumulates over the lifetime of the patient. 26 The impact of a CIED infection to the healthcare system is substantial, with each event costing $48 000 to $55 000 to treat.…”

“… 26 The impact of a CIED infection to the healthcare system is substantial, with each event costing $48 000 to $55 000 to treat. 1 , 25 , 27 – 29 To date, only the TYRX absorbable antibacterial envelope has been shown to significantly reduce the risk of CIED infection with the addition of preoperative antibiotics. 6 In addition to the prior finding that the antibacterial envelope is clinically effective, this analysis suggests that the envelope is also cost-effective in the US healthcare system.…”

Implantable cardioverter defibrillator therapy is cost effective for primary prevention patients in Taiwan: An analysis from the Improve SCA trial

“…We assumed half of the combined rate reported in the REPLACE registry could be attributed to lead failure (0.5%) and half could be attributed to lead dislodgement (0.5%). We estimated the one-year probability of lead infection after initial implant (1.22%) and after device replacement (2.16%) with a retrospective data analysis based on administrative claims from a large US insurer [21]. The lifetime risk of lead infection after the first year of an initial or replacement implant was double the value of the one-year claims-based probability [22].…”

Cost-Effectiveness Analyses of an Absorbable Antibacterial Envelope for Use in Patients at Increased Risk of Cardiac Implantable Electronic Device Infection in Germany, Italy, and England

“…[5][6][7][8][9][10][11] The incidence of CIED infections is estimated between 1% and 4% of CIED recipients. [5][6][7][8][12][13][14] In part due to the rising prevalence of certain risk factors among CIED recipients, the rate of CIED infection is reported to be increasing in excess of the implantation rate. 15 An infection risk score was developed from the Prevention of Arrhythmia Device Infection Trial (PADIT), as shown in the Supplemental Materials found at https://doi.org/10.1016/j.jval.202 0.12.021.…”