title: 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.
abstract: 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.
  
  
  
  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, $43 541, $48 759, and $362 606.
  
  
  
  The management of CIED infections results in a substantial healthcare burden with a significant increase in annual expenditures the year after implant when device infection occurs.
authors: From the Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN (M.R.S.); CRHF HEOR, Reimbursement and Evidence, Medtronic, Plc, Mounds View, MN (E.L.E.); Health Economics and Outcomes Research (M.P.R., C.G.) and Regulatory & Scientific Affairs (L.A.W.), CTI Clinical Trial and Consulting Services, Inc, Cincinnati, OH; and Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.).
authors: M Rizwan
authors: MR
authors: Sohail
authors: From the Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN (M.R.S.); CRHF HEOR, Reimbursement and Evidence, Medtronic, Plc, Mounds View, MN (E.L.E.); Health Economics and Outcomes Research (M.P.R., C.G.) and Regulatory & Scientific Affairs (L.A.W.), CTI Clinical Trial and Consulting Services, Inc, Cincinnati, OH; and Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.). Elizabeth.eby@medtronic.com.
authors: Elizabeth L
authors: EL
authors: Eby
authors: From the Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN (M.R.S.); CRHF HEOR, Reimbursement and Evidence, Medtronic, Plc, Mounds View, MN (E.L.E.); Health Economics and Outcomes Research (M.P.R., C.G.) and Regulatory & Scientific Affairs (L.A.W.), CTI Clinical Trial and Consulting Services, Inc, Cincinnati, OH; and Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.).
authors: Michael P
authors: MP
authors: Ryan
authors: From the Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN (M.R.S.); CRHF HEOR, Reimbursement and Evidence, Medtronic, Plc, Mounds View, MN (E.L.E.); Health Economics and Outcomes Research (M.P.R., C.G.) and Regulatory & Scientific Affairs (L.A.W.), CTI Clinical Trial and Consulting Services, Inc, Cincinnati, OH; and Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.).
authors: Candace
authors: C
authors: Gunnarsson
authors: From the Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN (M.R.S.); CRHF HEOR, Reimbursement and Evidence, Medtronic, Plc, Mounds View, MN (E.L.E.); Health Economics and Outcomes Research (M.P.R., C.G.) and Regulatory & Scientific Affairs (L.A.W.), CTI Clinical Trial and Consulting Services, Inc, Cincinnati, OH; and Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.).
authors: Laura A
authors: LA
authors: Wright
authors: From the Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN (M.R.S.); CRHF HEOR, Reimbursement and Evidence, Medtronic, Plc, Mounds View, MN (E.L.E.); Health Economics and Outcomes Research (M.P.R., C.G.) and Regulatory & Scientific Affairs (L.A.W.), CTI Clinical Trial and Consulting Services, Inc, Cincinnati, OH; and Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA (A.J.G.).
authors: Arnold J
authors: AJ
authors: Greenspon
mesh_terms: D000368:Aged; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D020878:Device Removal; D005260:Female; D005102:Health Expenditures; D006801:Humans; D015994:Incidence; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011159:Population Surveillance; D016459:Prosthesis-Related Infections / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: device removal; healthcare costs; incidence; infection; outpatients