Economic impact of cardiac implantable electronic device infections: cost analysis at one year in a large U.S. health insurer
Aims: Cardiac device infections (CDIs) are serious adverse events associated with morbidity and mortality, significant costs and increased healthcare utilization. The objective of the current study was to characterize the CDI rate by device type, risk factors for infection and healthcare costs from...
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| Veröffentlicht in: | Journal of medical economics 2020-07, Vol.23 (7), p.698-705 |
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| creator | Eby, Elizabeth L. Bengtson, Lindsay G. S. Johnson, Michael P. Burton, Mark L. Hinnenthal, Jennifer |
| description | Aims: Cardiac device infections (CDIs) are serious adverse events associated with morbidity and mortality, significant costs and increased healthcare utilization. The objective of the current study was to characterize the CDI rate by device type, risk factors for infection and healthcare costs from a large U.S. health insurer perspective.
Materials and Methods: A retrospective analysis of a large U.S. health insurer database identified commercial and Medicare Advantage with Part D (MAPD) members ≥18 years with ≥1 claim for a cardiac implantable electronic device (CIED) procedure between 01 October 2011 and 31 October 2015. CIEDs included pacemakers (IPG), implantable cardioverter defibrillators (ICDs), and cardiac resynchronization therapy - pacemakers without (CRT-P) and with defibrillation (CRT-D). Probabilities of CDI through one-year post implant were estimated using the Kaplan-Meier method. A regression model with stepwise variable selection was used to select risk factors associated with CDIs.
Results: A total of 63,406 patients were included with an overall CDI rate of 1.28% (1.0% de novo and 1.74% replacement devices), varying by device type: IPG = 0.91%; ICD = 1.63%; CRT-p = 1.50%; CRT-D = 2.22%. The average adjusted annual medical costs were 2.4 times greater [95% confidence interval (CI) = 2.1-2.7] for those with an infection compared to those without, and the incremental cost difference was estimated to be $57,322 [95% CI $46,572-$70,484]. Observed risk factors of CDIs included prior device infection [Odds ratio (OR) = 11.356; 95% CI = 7.923-16.276], undergoing a CIED replacement procedure (OR = 1.644; 95% CI = 1.361-1.987), implantation of a high-power device (OR = 1.354; 95% CI = 1.115-1.643), and younger age (age < 65) (OR = 1.607; 95% CI = 1.307-1.976).
Conclusions: The CDI rate at one year ranged from 0.91%-2.22% depending on device type. Management of CDIs among commercial and MAPD members is associated with high healthcare expenditures. |
| doi_str_mv | 10.1080/13696998.2020.1751649 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1080_13696998_2020_1751649</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2387254507</sourcerecordid><originalsourceid>FETCH-LOGICAL-c413t-10860503ce70092b67307aede11a485c736e5b8df249bff7c7762d57878db8683</originalsourceid><addsrcrecordid>eNp9kE1P3DAQhq2qVUGUn9DKRy5Z_BF_pKciRKESEgeK1Js1cSbFlRNv7SxoD_3v9bJLj_VlrFfPzGgeQj5ytuLMsnMudae7zq4EEzUyiuu2e0OOedfyxkrz4239V6bZQUfktJRfrD4pOTP8PTmSQiglrT4mf658mtMUPA3TGvxC00g95CHASxJhXqCPSDGiX3KaKzjgU_BIwzzWKKS5fKY-lYXCDHFbQqFQp8xItwi5UhRohPwT6cPqfkUfEeLyWOOyyZg_kHcjxIKnh3pCHr5efb-8aW7vrr9dXtw2vuVyaerNmikmPRrGOtFrI5kBHJBzaK3yRmpUvR1G0Xb9OBpvjBaDMtbYobfayhNytp-7zun3BsviplA8xnoepk1xQlojVKuYqajaoz6nUjKObp3DBHnrOHM7-e5VvtvJdwf5te_TYcWmn3D41_WqugJf9kAVl_IEzynHwS2wjSmPGWYfipP_3_EXAXSToA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2387254507</pqid></control><display><type>article</type><title>Economic impact of cardiac implantable electronic device infections: cost analysis at one year in a large U.S. health insurer</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Eby, Elizabeth L. ; Bengtson, Lindsay G. S. ; Johnson, Michael P. ; Burton, Mark L. ; Hinnenthal, Jennifer</creator><creatorcontrib>Eby, Elizabeth L. ; Bengtson, Lindsay G. S. ; Johnson, Michael P. ; Burton, Mark L. ; Hinnenthal, Jennifer</creatorcontrib><description>Aims: Cardiac device infections (CDIs) are serious adverse events associated with morbidity and mortality, significant costs and increased healthcare utilization. The objective of the current study was to characterize the CDI rate by device type, risk factors for infection and healthcare costs from a large U.S. health insurer perspective.
Materials and Methods: A retrospective analysis of a large U.S. health insurer database identified commercial and Medicare Advantage with Part D (MAPD) members ≥18 years with ≥1 claim for a cardiac implantable electronic device (CIED) procedure between 01 October 2011 and 31 October 2015. CIEDs included pacemakers (IPG), implantable cardioverter defibrillators (ICDs), and cardiac resynchronization therapy - pacemakers without (CRT-P) and with defibrillation (CRT-D). Probabilities of CDI through one-year post implant were estimated using the Kaplan-Meier method. A regression model with stepwise variable selection was used to select risk factors associated with CDIs.
Results: A total of 63,406 patients were included with an overall CDI rate of 1.28% (1.0% de novo and 1.74% replacement devices), varying by device type: IPG = 0.91%; ICD = 1.63%; CRT-p = 1.50%; CRT-D = 2.22%. The average adjusted annual medical costs were 2.4 times greater [95% confidence interval (CI) = 2.1-2.7] for those with an infection compared to those without, and the incremental cost difference was estimated to be $57,322 [95% CI $46,572-$70,484]. Observed risk factors of CDIs included prior device infection [Odds ratio (OR) = 11.356; 95% CI = 7.923-16.276], undergoing a CIED replacement procedure (OR = 1.644; 95% CI = 1.361-1.987), implantation of a high-power device (OR = 1.354; 95% CI = 1.115-1.643), and younger age (age < 65) (OR = 1.607; 95% CI = 1.307-1.976).
Conclusions: The CDI rate at one year ranged from 0.91%-2.22% depending on device type. Management of CDIs among commercial and MAPD members is associated with high healthcare expenditures.</description><identifier>ISSN: 1369-6998</identifier><identifier>EISSN: 1941-837X</identifier><identifier>DOI: 10.1080/13696998.2020.1751649</identifier><identifier>PMID: 32255386</identifier><language>eng</language><publisher>England: Taylor & Francis</publisher><subject>Aged ; Aged, 80 and over ; cardiac device infections ; Cardiac implantable electronic device ; Costs and Cost Analysis ; Defibrillators, Implantable - adverse effects ; Female ; healthcare costs ; Humans ; Insurance Carriers - economics ; Male ; Medicare Part D - economics ; Middle Aged ; morbidity ; outcomes research ; Prosthesis-Related Infections - economics ; Prosthesis-Related Infections - physiopathology ; Retrospective Studies ; United States</subject><ispartof>Journal of medical economics, 2020-07, Vol.23 (7), p.698-705</ispartof><rights>2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c413t-10860503ce70092b67307aede11a485c736e5b8df249bff7c7762d57878db8683</citedby><cites>FETCH-LOGICAL-c413t-10860503ce70092b67307aede11a485c736e5b8df249bff7c7762d57878db8683</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32255386$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Eby, Elizabeth L.</creatorcontrib><creatorcontrib>Bengtson, Lindsay G. S.</creatorcontrib><creatorcontrib>Johnson, Michael P.</creatorcontrib><creatorcontrib>Burton, Mark L.</creatorcontrib><creatorcontrib>Hinnenthal, Jennifer</creatorcontrib><title>Economic impact of cardiac implantable electronic device infections: cost analysis at one year in a large U.S. health insurer</title><title>Journal of medical economics</title><addtitle>J Med Econ</addtitle><description>Aims: Cardiac device infections (CDIs) are serious adverse events associated with morbidity and mortality, significant costs and increased healthcare utilization. The objective of the current study was to characterize the CDI rate by device type, risk factors for infection and healthcare costs from a large U.S. health insurer perspective.
Materials and Methods: A retrospective analysis of a large U.S. health insurer database identified commercial and Medicare Advantage with Part D (MAPD) members ≥18 years with ≥1 claim for a cardiac implantable electronic device (CIED) procedure between 01 October 2011 and 31 October 2015. CIEDs included pacemakers (IPG), implantable cardioverter defibrillators (ICDs), and cardiac resynchronization therapy - pacemakers without (CRT-P) and with defibrillation (CRT-D). Probabilities of CDI through one-year post implant were estimated using the Kaplan-Meier method. A regression model with stepwise variable selection was used to select risk factors associated with CDIs.
Results: A total of 63,406 patients were included with an overall CDI rate of 1.28% (1.0% de novo and 1.74% replacement devices), varying by device type: IPG = 0.91%; ICD = 1.63%; CRT-p = 1.50%; CRT-D = 2.22%. The average adjusted annual medical costs were 2.4 times greater [95% confidence interval (CI) = 2.1-2.7] for those with an infection compared to those without, and the incremental cost difference was estimated to be $57,322 [95% CI $46,572-$70,484]. Observed risk factors of CDIs included prior device infection [Odds ratio (OR) = 11.356; 95% CI = 7.923-16.276], undergoing a CIED replacement procedure (OR = 1.644; 95% CI = 1.361-1.987), implantation of a high-power device (OR = 1.354; 95% CI = 1.115-1.643), and younger age (age < 65) (OR = 1.607; 95% CI = 1.307-1.976).
Conclusions: The CDI rate at one year ranged from 0.91%-2.22% depending on device type. Management of CDIs among commercial and MAPD members is associated with high healthcare expenditures.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>cardiac device infections</subject><subject>Cardiac implantable electronic device</subject><subject>Costs and Cost Analysis</subject><subject>Defibrillators, Implantable - adverse effects</subject><subject>Female</subject><subject>healthcare costs</subject><subject>Humans</subject><subject>Insurance Carriers - economics</subject><subject>Male</subject><subject>Medicare Part D - economics</subject><subject>Middle Aged</subject><subject>morbidity</subject><subject>outcomes research</subject><subject>Prosthesis-Related Infections - economics</subject><subject>Prosthesis-Related Infections - physiopathology</subject><subject>Retrospective Studies</subject><subject>United States</subject><issn>1369-6998</issn><issn>1941-837X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>0YH</sourceid><sourceid>EIF</sourceid><recordid>eNp9kE1P3DAQhq2qVUGUn9DKRy5Z_BF_pKciRKESEgeK1Js1cSbFlRNv7SxoD_3v9bJLj_VlrFfPzGgeQj5ytuLMsnMudae7zq4EEzUyiuu2e0OOedfyxkrz4239V6bZQUfktJRfrD4pOTP8PTmSQiglrT4mf658mtMUPA3TGvxC00g95CHASxJhXqCPSDGiX3KaKzjgU_BIwzzWKKS5fKY-lYXCDHFbQqFQp8xItwi5UhRohPwT6cPqfkUfEeLyWOOyyZg_kHcjxIKnh3pCHr5efb-8aW7vrr9dXtw2vuVyaerNmikmPRrGOtFrI5kBHJBzaK3yRmpUvR1G0Xb9OBpvjBaDMtbYobfayhNytp-7zun3BsviplA8xnoepk1xQlojVKuYqajaoz6nUjKObp3DBHnrOHM7-e5VvtvJdwf5te_TYcWmn3D41_WqugJf9kAVl_IEzynHwS2wjSmPGWYfipP_3_EXAXSToA</recordid><startdate>20200702</startdate><enddate>20200702</enddate><creator>Eby, Elizabeth L.</creator><creator>Bengtson, Lindsay G. S.</creator><creator>Johnson, Michael P.</creator><creator>Burton, Mark L.</creator><creator>Hinnenthal, Jennifer</creator><general>Taylor & Francis</general><scope>0YH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20200702</creationdate><title>Economic impact of cardiac implantable electronic device infections: cost analysis at one year in a large U.S. health insurer</title><author>Eby, Elizabeth L. ; Bengtson, Lindsay G. S. ; Johnson, Michael P. ; Burton, Mark L. ; Hinnenthal, Jennifer</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c413t-10860503ce70092b67307aede11a485c736e5b8df249bff7c7762d57878db8683</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>cardiac device infections</topic><topic>Cardiac implantable electronic device</topic><topic>Costs and Cost Analysis</topic><topic>Defibrillators, Implantable - adverse effects</topic><topic>Female</topic><topic>healthcare costs</topic><topic>Humans</topic><topic>Insurance Carriers - economics</topic><topic>Male</topic><topic>Medicare Part D - economics</topic><topic>Middle Aged</topic><topic>morbidity</topic><topic>outcomes research</topic><topic>Prosthesis-Related Infections - economics</topic><topic>Prosthesis-Related Infections - physiopathology</topic><topic>Retrospective Studies</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Eby, Elizabeth L.</creatorcontrib><creatorcontrib>Bengtson, Lindsay G. S.</creatorcontrib><creatorcontrib>Johnson, Michael P.</creatorcontrib><creatorcontrib>Burton, Mark L.</creatorcontrib><creatorcontrib>Hinnenthal, Jennifer</creatorcontrib><collection>Taylor & Francis Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of medical economics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Eby, Elizabeth L.</au><au>Bengtson, Lindsay G. S.</au><au>Johnson, Michael P.</au><au>Burton, Mark L.</au><au>Hinnenthal, Jennifer</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Economic impact of cardiac implantable electronic device infections: cost analysis at one year in a large U.S. health insurer</atitle><jtitle>Journal of medical economics</jtitle><addtitle>J Med Econ</addtitle><date>2020-07-02</date><risdate>2020</risdate><volume>23</volume><issue>7</issue><spage>698</spage><epage>705</epage><pages>698-705</pages><issn>1369-6998</issn><eissn>1941-837X</eissn><abstract>Aims: Cardiac device infections (CDIs) are serious adverse events associated with morbidity and mortality, significant costs and increased healthcare utilization. The objective of the current study was to characterize the CDI rate by device type, risk factors for infection and healthcare costs from a large U.S. health insurer perspective.
Materials and Methods: A retrospective analysis of a large U.S. health insurer database identified commercial and Medicare Advantage with Part D (MAPD) members ≥18 years with ≥1 claim for a cardiac implantable electronic device (CIED) procedure between 01 October 2011 and 31 October 2015. CIEDs included pacemakers (IPG), implantable cardioverter defibrillators (ICDs), and cardiac resynchronization therapy - pacemakers without (CRT-P) and with defibrillation (CRT-D). Probabilities of CDI through one-year post implant were estimated using the Kaplan-Meier method. A regression model with stepwise variable selection was used to select risk factors associated with CDIs.
Results: A total of 63,406 patients were included with an overall CDI rate of 1.28% (1.0% de novo and 1.74% replacement devices), varying by device type: IPG = 0.91%; ICD = 1.63%; CRT-p = 1.50%; CRT-D = 2.22%. The average adjusted annual medical costs were 2.4 times greater [95% confidence interval (CI) = 2.1-2.7] for those with an infection compared to those without, and the incremental cost difference was estimated to be $57,322 [95% CI $46,572-$70,484]. Observed risk factors of CDIs included prior device infection [Odds ratio (OR) = 11.356; 95% CI = 7.923-16.276], undergoing a CIED replacement procedure (OR = 1.644; 95% CI = 1.361-1.987), implantation of a high-power device (OR = 1.354; 95% CI = 1.115-1.643), and younger age (age < 65) (OR = 1.607; 95% CI = 1.307-1.976).
Conclusions: The CDI rate at one year ranged from 0.91%-2.22% depending on device type. Management of CDIs among commercial and MAPD members is associated with high healthcare expenditures.</abstract><cop>England</cop><pub>Taylor & Francis</pub><pmid>32255386</pmid><doi>10.1080/13696998.2020.1751649</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over cardiac device infections Cardiac implantable electronic device Costs and Cost Analysis Defibrillators, Implantable - adverse effects Female healthcare costs Humans Insurance Carriers - economics Male Medicare Part D - economics Middle Aged morbidity outcomes research Prosthesis-Related Infections - economics Prosthesis-Related Infections - physiopathology Retrospective Studies United States |
| title | Economic impact of cardiac implantable electronic device infections: cost analysis at one year in a large U.S. health insurer |
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