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Cost implications of defibrillator lead failures.
MedLine Citation:
PMID:  22333240     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AimsThe prevalence of lead failures is increasing with a growing population of implantable cardioverter defibrillator (ICD) recipients. The cost of managing defibrillator lead failures requires investigation.Methods and resultsA retrospective cohort study of patients requiring lead replacement for defibrillator lead failure was performed. Details pertaining to admissions were recorded. The cost per lead replacement was determined. Twenty-three patients {mean age [standard deviation (SD); range] = 56 (17; 18-83) years; 87% male} underwent lead replacement at a mean (SD; range) interval from implant of 3.0 (1.8; 0.9-9.0) years. The median (SD; range) length of hospital stay was 4.5 (8.6; 1-43) days. Procedure-related complications were recorded for three (13%) patients. Thirty days and 1-year mortality were 0 and 4% (1 of 23). The median (SD; range) cost per lead replacement was €7660 (€10 964; €1472-39 663). Bed day costs accounted for 54% of overall costs. Extraction of the failed lead by manual traction at time of lead replacement did not significantly increase costs. The median (SD; range) cost of lead replacement was higher in patients receiving a new ICD generator (n= 6), compared with patients retaining existing generators (n= 17): €23 394 (€5026; €17 266-31 245) vs. €4470 (€9080; €1472-39 663); P= 0.005. The median (SD; range) cost of lead replacement among patients who remained in hospital pending lead replacement (n= 16) was higher than for patients who underwent replacement on an emergent outpatient basis (n= 7): €8508 (€11 920; €1472-39 663) vs. €4372 (€7256; €1555-20 478); however, this observation was not statistically significant, P= 0.21.ConclusionsDefibrillator lead failures incur significant cost and are likely to undermine overall cost effectiveness of ICDs. Cost-effectiveness analyses of device therapy should include costs related to such complications.
Authors:
John D Groarke; Una Buckley; Damien Collison; James O'Neill; Niall G Mahon; Brendan Foley
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-14
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  -     ISSN:  1532-2092     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Department of Cardiology, St James's Hospital, James's Street, Dublin 8, Ireland.
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