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Circulation: Arrhythmia and Electrophysiology
Previous studies of costs related to device infections have been limited to those during the hospitalization. This study, which included costs incurred during subsequent care found very high 1- year costs associated with device infections. These substantial costs support dedication of resources to reduce infection rates.
Incidence, Treatment Intensity, and Incremental Annual Expenditures for Patients Experiencing a Cardiac Implantable Electronic Device Infection
Evidence From a Large US Payer Database 1-Year Post Implantation
M. Rizwan Sohail, MD Elizabeth L. Eby, MPH Michael P. Ryan, MS Candace Gunnarsson, EdD Laura A. Wright, PhD Arnold J. Greenspon, MD
Correspondence to: Elizabeth L. Eby, MPH, Medtronic, Plc, 8200 Coral Sea St NE, Mounds View, MN 55112. E-mail Elizabeth.firstname.lastname@example.org
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, …