title: The economic impact of battery longevity in implantable cardioverter-defibrillators for cardiac resynchronization therapy: the hospital and healthcare system perspectives.
abstract: OBJECTIVE
  Patients receiving cardiac resynchronization therapy defibrillators (CRT-Ds) are likely to undergo one or more device replacements, mainly for battery depletion. We assessed the economic impact of battery depletion on the overall cost of CRT-D treatment from the perspectives of the healthcare system and the hospital. We also compared devices of different generations and from different manufacturers in terms of therapy cost.
  
  
  RESULTS
  We analysed data on 1792 CRT-Ds implanted in 1399 patients in 9 Italian centres. We calculated the replacement probability and the total therapy cost over 6 years, stratified by device generation and manufacturer. Public tariffs from diagnosis-related groups were used together with device prices and hospitalization costs. Generators were from 3 manufacturers: Boston Scientific (667, 37%), Medtronic (973, 54%), and St Jude Medical (152, 9%). The replacement probability at 6 years was 83 and 68% for earlier- and recent-generation devices, respectively. The need for replacement increased total therapy costs by more than 50% over the initial implantation cost for hospitals and by more than 30% for healthcare system. The improved longevity of recent-generation CRT-Ds reduced the therapy cost by ∼6% in both perspectives. Among recent-generation CRT-Ds, the replacement probability of devices from different manufacturers ranged from 12 to 70%. Consequently, the maximum difference in therapy cost between manufacturers was 40% for hospitals and 19% for the healthcare system.
  
  
  CONCLUSIONS
  Differences in CRT-D longevity strongly affect the overall therapy cost. While the use of recent-generation devices has reduced the cost, significant differences exist among currently available systems.
authors.affiliation: Dipartimento di Cardiologia, A.O. Ospedale Maggiore, Largo Ugo Dossena 2, Crema (Cremona) 26013, Italy.|Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Landolina
authors.affiliation: Ospedale Civile Maggiore di Borgo Trento, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Morani
authors.affiliation: Ospedali Civili, Brescia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Curnis
authors.affiliation: A.S. Ospedaliera S. Croce e Carle, Cuneo, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Vado
authors.affiliation: Azienda Ospedaliera dei Colli-Monaldi, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Onofrio
authors.affiliation: Azienda Ospedaliera dei Colli-Monaldi, Naples, Italy.
authors.forename: Valter
authors.initials: V
authors.lastname: Bianchi
authors.affiliation: Clinica Mediterranea, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Stabile
authors.affiliation: Treviso Hospital 'Ca' Foncello', Treviso, Italy.
authors.forename: Martino
authors.initials: M
authors.lastname: Crosato
authors.affiliation: Fondazione Policlinico S. Matteo IRCCS, Pavia, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Petracci
authors.affiliation: Humanitas Research Hospital IRCCS, Rozzano (Milan), Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Ceriotti
authors.affiliation: Ospedali Civili, Brescia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Bontempi
authors.affiliation: Ospedale Civile Maggiore di Borgo Trento, Verona, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Morosato
authors.affiliation: A.S. Ospedaliera S. Croce e Carle, Cuneo, Italy.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Ballari
authors.affiliation: Humanitas Research Hospital IRCCS, Rozzano (Milan), Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gasparini
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000191:economics*; D058409:Cardiac Resynchronization Therapy Devices / Q000191:economics*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D017147:Defibrillators, Implantable / Q000191:economics*; D020878:Device Removal / Q000191:economics*; D004554:Electric Countershock / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation*; D011211:Electric Power Supplies / Q000191:economics*; D004867:Equipment Design; D004868:Equipment Failure; D017048:Health Care Costs; D005102:Health Expenditures; D006333:Heart Failure / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D006801:Humans; D007558:Italy; D018803:Models, Economic; D013997:Time Factors
keywords: Battery; Cardiac resynchronization therapy; Cost analysis; Defibrillator; Device longevity