Incidence, Treatment Intensity, and Incremental Annual Expenditures for Patients Experiencing a Cardiac Implantable Electronic Device Infection

Abstract

Background— Because of the increasing use of cardiac implantable electronic devices (CIEDs), it is important to estimate the incidence and annual healthcare expenditures associated with CIED infections. Methods and Results— Patients with a record of an initial or replacement (full implant or generator only) CIED implant during the calendar years 2009 to 2012 in MarketScan Commercial Claims and Medicare Supplemental database were identified. CIED infections were classified into 4 categories: (1) infection not managed by inpatient admission nor implant removal, (2) infection managed by inpatient admission but no implant removal, (3) infection managed by an implant removal either in an inpatient or in an outpatient setting, and (4) infection with severe sepsis and managed in an inpatient setting with implant removal. Using separate models for initial and replacement cohorts, annualized incidence of infection and incremental annual expenditures by treatment intensity were estimated. Cumulative incidence of infection at 1 year post implant was 1.18% for initial CIED implants and 2.37% for replacement. Median time to infection was 35 days for initial and 23 days for replacement. Incremental healthcare expenditures by treatment intensity categories for initial implant patients at 1 year were $16 651, $104 077, $45 291, and $279 744. For replacement patients, incremental expenditures at 1 year by treatment intensity categories were $26 857, $43 541, $48 759, and $362 606. Conclusions— The management of CIED infections results in a substantial healthcare burden with a significant increase in annual expenditures the year after implant when device infection occurs.

Incidence and costs of cardiac device infections: retrospective analysis using German health claims data

“…The rate was higher for replacement as opposed to de novo implants (4.4 vs 2.9%), as reported in previous studies [12,17].…”

“…A study of CDI in seven pacemaker patients in Germany estimated a mean additional hospital cost of €7091 [20]. In an administrative claims database analysis in the USA, similar in methodology to our study, the estimated incremental healthcare expenditures for patients with an infection were €44,099 ($47,885) for de novo implants and €41,913 ($45,512) for replacement patients [12].…”

“…Similar rates of nonremoval of devices were observed in a recent study of CDIs also using health insurance claims data [12]. These are high rates of conservative management, given the recommendations from medical societies in favor of complete device system removal due to increased mortality in case of nonremoval [5][6][7].…”

“…In the USA, incremental healthcare expenditures for patients with CDI within 12 months of implant are estimated at €44,099 ($47,885) for initially implanted patients and €41,913 ($45,512) for replacement patients [12]. Notably, these costs included large proportions of all implanted patients (38.4% of initial and 47.2% of replacement cohorts) with superficial infections treated out-of-hospital and without device-related intervention.…”

Costs and complications associated with transvenous lead reoperation in cardiac implantable electronic devices

“…Finally, while other studies have included diverse populations of private and publicly insured patients,[7][8][9][10][11] in which the distinction between actual payer costs and provider submitted charges may be less clear and result in inflated cost estimates, we F I G U R E 6 Adjusted length of stay and costs of inpatient lead removal, by the presence of infection. In this study, we observed an increase in complication rates beginning roughly 90 days before TV lead reoperation, and a decrease after reoperation, with a similar pattern in costs.…”