title: Cost implications of defibrillator lead failures.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Cardiology, St James's Hospital, James's Street, Dublin 8, Ireland. johngroarke1@eircom.net
authors.forename: John D
authors.initials: JD
authors.lastname: Groarke
authors.forename: Una
authors.initials: U
authors.lastname: Buckley
authors.forename: Damien
authors.initials: D
authors.lastname: Collison
authors.forename: James
authors.initials: J
authors.lastname: O'Neill
authors.forename: Niall G
authors.initials: NG
authors.lastname: Mahon
authors.forename: Brendan
authors.initials: B
authors.lastname: Foley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D017147:Defibrillators, Implantable / Q000191:economics*; D004868:Equipment Failure / Q000191:economics*; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult