Cost implications of defibrillator lead failures

Abstract

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; 1883) years; 87 male underwent lead replacement at a mean (SD; range) interval from implant of 3.0 (1.8; 0.99.0) years. The median (SD; range) length of hospital stay was 4.5 (8.6; 143) 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; €147239 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 26631 245) vs. €4470 (€9080; €147239 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; €147239 663) vs. €4372 (€7256; €155520 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. © 2012 The Author.