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

Abstract

AimsPatients 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.Methods and resultsWe 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.ConclusionsDifferences 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.

First Demonstration of Cardiac Resynchronization Therapy Defibrillator Service Life Exceeding Patient Survival in a Heart Failure with Reduced Ejection Fraction Cohort

“…Device replacement not only increases the risk of complications but also the total cost of therapy given the additional procedures required and extra costs associated with managing replacement-related complications. 21 The longevity of CRT-D batteries has been found to be shorter than that of single- and dual-chamber defibrillator batteries 23 and, historically, ERI has been the most frequent cause of device replacement reported in prior studies. 2 , 24 , 25 To our knowledge, our study is the first to report patient deaths as a more frequent cause of CRT-D OOS (mean time to death: 2.3 ± 2.1 years) rather than ERI (mean time to ERI: 7.8 ± 1.5 years), likely due to our focus on 2.1-Ah battery CRT-D systems.…”

“…CRT-D replacement due to battery depletion is a significant cost-driver for payors 21 , 26 and a significant complication-driver for patients. 9 , 18 Landolina et al found the need for device replacements at six years was reduced from 83% to 68% with the use of devices with improved battery longevity from the most recent generation.…”

“Real life” longevity of implantable cardioverter‐defibrillator devices

“…Even among those 14 patients with ample use of ICD electrical therapy or an electrical storm, only 1 was apparently affected and presented premature battery depletion. Although reports of longevity have indicated a progressive increase of the life span of ICD devices over the years, from a mean of 19 months in 1980 to 48 months in 2009 to 65 months in 2015, there is still room for improvement, as this is quite an expensive therapy and patient and physician expectations run high for a more satisfactory performance of these devices, a crucial determinant of cost‐efficacy of ICD therapy . Reducing the frequency of generator replacements would also reduce the frequency of important complications, such as device infection, and their consequent costs .…”

“…Indeed, for CRT to be effective, constant left ventricular or biventricular pacing is a prerequisite to ensure left ventricular resynchronization . According to a recent study in a large cohort of 1399 patients treated with CRT‐D, device replacement for battery depletion proved to be a significant cost driver, whereby improved longevity observed with newer‐generation devices reduced the therapy cost . Furthermore, differences were also observed among CRT‐D systems from different manufacturers.…”

“…In the present series of 685 patients receiving an ICD device over the last 20 years, pulse generator replacement was needed in 238 patients (~35% 16 to 65 months in 2015, 17 there is still room for improvement, as this is quite an expensive therapy and patient and physician expectations run high for a more satisfactory performance of these devices, a crucial determinant of cost-efficacy of ICD therapy. 18 Reducing the frequency of generator replacements would also reduce the frequency of important complications, such as device infection, and their consequent costs. [19][20][21] Real-life longevity is definitely sharply shorter compared with the industry-projected longevity, which has always overestimated ICD device performance.…”