What is the cost of non-response to cardiac resynchronization therapy? Hospitalizations and healthcare utilization in the CRT-D population.
BACKGROUND
Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure (HF) with left ventricular systolic dysfunction and prolonged QRS interval. However, one third of patients do not benefit from treatment. This study compares the heart failure hospitalization (HFH) rates and corresponding costs between responders and non-responders to CRT.


METHODS
At a single center in New Jersey, we enrolled patients with de novo CRT-D implants between January 2011 and July 2013. Medical history at implant and all subsequent hospitalizations were collected. A retrospective chart review of the cardiology visit at or closest to 12 months post-CRT implant was performed, and patients were classified into responders and non-responders. Universal billing records (UB-04), ICD-9-CM diagnoses, and procedure codes were used to determine whether each hospitalization was due to HF. For each heart failure hospitalization (HFH), an MS-DRG-based US national average Medicare reimbursement was determined. HFH rates and associated payor costs were compared between responders and non-responders using negative binomial regression and non-parametric bootstrapping (×10,000), respectively.


RESULTS
CRT response was determined in 135 patients (n = 103 responders, n = 32 non-responders, average follow-up 1.4 years). Demographics, pre-implant HF characteristics, NYHA Class, QRS duration, ejection fraction (EF), left bundle branch block (LBBB) status, and co-morbidities were not statistically different between the two groups. The HFH rate was significantly lower in responders (0.43/patient year) compared to non-responders (0.96/patient year, IRR = 0.45, 95 % CI (0.23 0.90), P = 0.0197). Average US national Medicare reimbursement for the responder group (US$7205/patient year) was 48 % lower than that for the non-responder group (US$13,861/patient year, P = 0.035).


CONCLUSIONS
In this single-center retrospective study, responders to CRT had significantly lower rates of post-implant heart failure hospitalization rate and reduced associated payor costs compared to non-responders. Therapies that increase CRT response rates can substantially reduce healthcare utilization.
Deborah Heart and Lung Cente, Browns Mills, NJ, USA. corbisieror@deborah.org.
Raffaele
R
Corbisiero
Deborah Heart and Lung Cente, Browns Mills, NJ, USA.
David C
DC
Buck
St. Jude Medical, Sylmar, CA, USA.
David
D
Muller
St. Jude Medical, Sylmar, CA, USA.
Rupinder
R
Bharmi
St. Jude Medical, Sylmar, CA, USA.
Nirav
N
Dalal
Deborah Heart and Lung Cente, Browns Mills, NJ, USA.
Pedram
P
Kazemian
D000368:Aged; D017281:Cost of Illness; D017147:Defibrillators, Implantable / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009515:New Jersey / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D017211:Treatment Failure; D014600:Utilization Review
Cardiac resynchronization therapy; Cost; Heart failure; Non-responder; Outcomes