1. Financial and resource costs of transvenous lead extraction in a high-volume lead extraction centre.
- Author
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Gould, Justin, Sidhu, Baldeep S., Porter, Bradley, Sieniewicz, Benjamin J., Freeman, Scott, de Wilt, Evelien C. J., Glover, Julia C., Razavi, Reza, Rinaldi, Christopher A., and de Wilt, Evelien Cj
- Subjects
IMPLANTABLE cardioverter-defibrillators ,CARDIAC pacing ,REIMBURSEMENT ,MEDICAL care costs ,NATIONAL health services ,HEART valves ,PUBLIC hospitals ,HOSPITALS ,LENGTH of stay in hospitals ,RESEARCH ,MEDICAL device removal ,TIME ,RESEARCH methodology ,HOSPITAL costs ,PATIENTS ,ACQUISITION of data ,MEDICAL cooperation ,EVALUATION research ,MEDICAL care use ,HOSPITAL admission & discharge ,HEALTH insurance reimbursement ,TREATMENT effectiveness ,COMPARATIVE studies ,COST effectiveness ,RESEARCH funding ,CARDIAC pacemakers ,LONGITUDINAL method ,ECONOMICS - Abstract
Objectives: Transvenous lead extraction (TLE) poses a significant economic and resource burden on healthcare systems; however, limited data exist on its true cost. We therefore estimate real-world healthcare reimbursement costs of TLE to the UK healthcare system at a single extraction centre.Methods: Consecutive admissions entailing TLE at a high-volume UK centre between April 2013 and March 2018 were prospectively recorded in a computer registry. In the hospital's National Health Service (NHS) clinical coding/reimbursement database, 447 cases were identified. Mean reimbursement cost (n=445) and length of stay (n=447) were calculated. Ordinary least squares regressions estimated the relationship between cost (bed days) and clinical factors.Results: Mean reimbursement cost per admission was £17 399.09±£13 966.49. Total reimbursement for all TLE admissions was £7 777 393.51. Mean length of stay was 16.3±15.16 days with a total of 7199 bed days. Implantable cardioverter-defibrillator and cardiac resynchronisation therapy defibrillator devices incurred higher reimbursement costs (70.5% and 68.7% higher, respectively, both p<0.001). Heart failure and prior valve surgery also incurred significantly higher reimbursement costs. Prior valve surgery and heart failure were associated with 8.3 (p=0.017) and 5.5 (p=0.021) additional days in hospital, respectively.Conclusions: Financial costs to the NHS from TLE are substantial. Consideration should therefore be given to cost/resource-sparing potential of leadless/extravascular cardiac devices that negate the need for TLE particularly in patients with prior valve surgery and/or heart failure. Additionally, use of antibiotic envelopes and other interventions that reduce infection risk in patients receiving transvenous leads should be considered. [ABSTRACT FROM AUTHOR]- Published
- 2020
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