Cost implications of defibrillator lead failures.

Aims: The 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 Results: A 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.
Conclusions: Defibrillator 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.