title: Investigating Regional Variation of Cardiac Implantable Electrical Device Implant Rates in European Healthcare Systems: What Drives Differences?
abstract: Despite established efficacy for cardiac implantable electrical devices (CIEDs), large differences in CIED implant rates have been documented across and within countries. The aim of this paper is to investigate the influence of socio-economic, epidemiological and supply side factors on CIED implant rates across 57 Regions in 5 EU countries and to assess the feasibility of using administrative data for this purpose. A total of 1 330 098 hospitalizations for CIED procedures extracted from hospital discharge databases in Austria, England, Germany, Italy and Slovenia from 2008 to 2012 was used in the analysis. Higher levels of tertiary education among the labour force and percent of aged population are positively associated with implant rates of CIED. Regional per capita GDP and number of implanting centres appear to have no significant effect. Institutional factors are shown to be important for the diffusion of CIED. Wide variation in CIED implant rates across and within five EU countries is undeniable. However, regional factors play a limited part in explaining these differences with few exceptions. Administrative databases are a valuable source of data for investigating the diffusion of medical technologies, while the choice of appropriate modelling strategy is crucial in identifying the drivers for variation across countries. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.
authors.affiliation: Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy.|Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Torbica
authors.affiliation: Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy.
authors.forename: Helen
authors.initials: H
authors.lastname: Banks
authors.affiliation: Universita degli Studi di Bologna Azienda Ospedaliera Sant\'Orsola-Malpighi, Bologna, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Valzania
authors.affiliation: Modena University Hospital, Universita degli Studi di Modena e Reggio Emilia Facolta di Medicina e Chirurgia, Modena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy.|Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fattore
mesh_terms: D058409:Cardiac Resynchronization Therapy Devices / Q000191:economics*; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D017147:Defibrillators, Implantable / Q000191:economics*; D022062:Electrophysiologic Techniques, Cardiac / Q000191:economics* / Q000295:instrumentation; D005060:Europe; D005843:Geography; D006353:Heart-Assist Devices / Q000191:economics*; D006801:Humans; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D012044:Regression Analysis; D012959:Socioeconomic Factors
keywords: Europe; cardiovascular implant devices; diffusion; implant rates; regional variation