Financial and resource costs of transvenous lead extraction in a high-volume lead extraction centre

Justin Gould; Baldeep S. Sidhu; Bradley Porter; Benjamin J. Sieniewicz; Scott Freeman; Evelien C.J. De Wilt; Julia C. Glover; Reza Razavi; Christopher A. Rinaldi

doi:10.1136/heartjnl-2019-315839

Financial and resource costs of transvenous lead extraction in a high-volume lead extraction centre

Justin Gould^*, Baldeep S. Sidhu, Bradley Porter, Benjamin J. Sieniewicz, Scott Freeman, Evelien C.J. De Wilt, Julia C. Glover, Reza Razavi, Christopher A. Rinaldi

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Objectives: Transvenous lead extraction (TLE) poses a significant economic and resource burden on healthcare systems; however, limited data exist on its true cost. We therefore estimate real-world healthcare reimbursement costs of TLE to the UK healthcare system at a single extraction centre. Methods: Consecutive admissions entailing TLE at a high-volume UK centre between April 2013 and March 2018 were prospectively recorded in a computer registry. In the hospital's National Health Service (NHS) clinical coding/reimbursement database, 447 cases were identified. Mean reimbursement cost (n=445) and length of stay (n=447) were calculated. Ordinary least squares regressions estimated the relationship between cost (bed days) and clinical factors. Results: Mean reimbursement cost per admission was £17 399.09±£13 966.49. Total reimbursement for all TLE admissions was £7 777 393.51. Mean length of stay was 16.3±15.16 days with a total of 7199 bed days. Implantable cardioverter-defibrillator and cardiac resynchronisation therapy defibrillator devices incurred higher reimbursement costs (70.5% and 68.7% higher, respectively, both p<0.001). Heart failure and prior valve surgery also incurred significantly higher reimbursement costs. Prior valve surgery and heart failure were associated with 8.3 (p=0.017) and 5.5 (p=0.021) additional days in hospital, respectively. Conclusions: Financial costs to the NHS from TLE are substantial. Consideration should therefore be given to cost/resource-sparing potential of leadless/extravascular cardiac devices that negate the need for TLE particularly in patients with prior valve surgery and/or heart failure. Additionally, use of antibiotic envelopes and other interventions that reduce infection risk in patients receiving transvenous leads should be considered.

Original language	English
Article number	e2019315839
Journal	Heart
DOIs	https://doi.org/10.1136/heartjnl-2019-315839
Publication status	Published - 1 Jan 2020

Keywords

cardiac implantable electronic device complications
cost of lead extraction
transvenous lead extraction

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10.1136/heartjnl-2019-315839

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@article{b436587ceab24f3ba0d25e03e719fa7c,

title = "Financial and resource costs of transvenous lead extraction in a high-volume lead extraction centre",

abstract = "Objectives: Transvenous lead extraction (TLE) poses a significant economic and resource burden on healthcare systems; however, limited data exist on its true cost. We therefore estimate real-world healthcare reimbursement costs of TLE to the UK healthcare system at a single extraction centre. Methods: Consecutive admissions entailing TLE at a high-volume UK centre between April 2013 and March 2018 were prospectively recorded in a computer registry. In the hospital's National Health Service (NHS) clinical coding/reimbursement database, 447 cases were identified. Mean reimbursement cost (n=445) and length of stay (n=447) were calculated. Ordinary least squares regressions estimated the relationship between cost (bed days) and clinical factors. Results: Mean reimbursement cost per admission was £17 399.09±£13 966.49. Total reimbursement for all TLE admissions was £7 777 393.51. Mean length of stay was 16.3±15.16 days with a total of 7199 bed days. Implantable cardioverter-defibrillator and cardiac resynchronisation therapy defibrillator devices incurred higher reimbursement costs (70.5% and 68.7% higher, respectively, both p<0.001). Heart failure and prior valve surgery also incurred significantly higher reimbursement costs. Prior valve surgery and heart failure were associated with 8.3 (p=0.017) and 5.5 (p=0.021) additional days in hospital, respectively. Conclusions: Financial costs to the NHS from TLE are substantial. Consideration should therefore be given to cost/resource-sparing potential of leadless/extravascular cardiac devices that negate the need for TLE particularly in patients with prior valve surgery and/or heart failure. Additionally, use of antibiotic envelopes and other interventions that reduce infection risk in patients receiving transvenous leads should be considered.",

keywords = "cardiac implantable electronic device complications, cost of lead extraction, transvenous lead extraction",

author = "Justin Gould and Sidhu, {Baldeep S.} and Bradley Porter and Sieniewicz, {Benjamin J.} and Scott Freeman and {De Wilt}, {Evelien C.J.} and Glover, {Julia C.} and Reza Razavi and Rinaldi, {Christopher A.}",

year = "2020",

month = jan,

day = "1",

doi = "10.1136/heartjnl-2019-315839",

language = "English",

journal = "Heart",

issn = "1355-6037",

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T1 - Financial and resource costs of transvenous lead extraction in a high-volume lead extraction centre

AU - Gould, Justin

AU - Sidhu, Baldeep S.

AU - Porter, Bradley

AU - Sieniewicz, Benjamin J.

AU - Freeman, Scott

AU - De Wilt, Evelien C.J.

AU - Glover, Julia C.

AU - Razavi, Reza

AU - Rinaldi, Christopher A.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Objectives: Transvenous lead extraction (TLE) poses a significant economic and resource burden on healthcare systems; however, limited data exist on its true cost. We therefore estimate real-world healthcare reimbursement costs of TLE to the UK healthcare system at a single extraction centre. Methods: Consecutive admissions entailing TLE at a high-volume UK centre between April 2013 and March 2018 were prospectively recorded in a computer registry. In the hospital's National Health Service (NHS) clinical coding/reimbursement database, 447 cases were identified. Mean reimbursement cost (n=445) and length of stay (n=447) were calculated. Ordinary least squares regressions estimated the relationship between cost (bed days) and clinical factors. Results: Mean reimbursement cost per admission was £17 399.09±£13 966.49. Total reimbursement for all TLE admissions was £7 777 393.51. Mean length of stay was 16.3±15.16 days with a total of 7199 bed days. Implantable cardioverter-defibrillator and cardiac resynchronisation therapy defibrillator devices incurred higher reimbursement costs (70.5% and 68.7% higher, respectively, both p<0.001). Heart failure and prior valve surgery also incurred significantly higher reimbursement costs. Prior valve surgery and heart failure were associated with 8.3 (p=0.017) and 5.5 (p=0.021) additional days in hospital, respectively. Conclusions: Financial costs to the NHS from TLE are substantial. Consideration should therefore be given to cost/resource-sparing potential of leadless/extravascular cardiac devices that negate the need for TLE particularly in patients with prior valve surgery and/or heart failure. Additionally, use of antibiotic envelopes and other interventions that reduce infection risk in patients receiving transvenous leads should be considered.

AB - Objectives: Transvenous lead extraction (TLE) poses a significant economic and resource burden on healthcare systems; however, limited data exist on its true cost. We therefore estimate real-world healthcare reimbursement costs of TLE to the UK healthcare system at a single extraction centre. Methods: Consecutive admissions entailing TLE at a high-volume UK centre between April 2013 and March 2018 were prospectively recorded in a computer registry. In the hospital's National Health Service (NHS) clinical coding/reimbursement database, 447 cases were identified. Mean reimbursement cost (n=445) and length of stay (n=447) were calculated. Ordinary least squares regressions estimated the relationship between cost (bed days) and clinical factors. Results: Mean reimbursement cost per admission was £17 399.09±£13 966.49. Total reimbursement for all TLE admissions was £7 777 393.51. Mean length of stay was 16.3±15.16 days with a total of 7199 bed days. Implantable cardioverter-defibrillator and cardiac resynchronisation therapy defibrillator devices incurred higher reimbursement costs (70.5% and 68.7% higher, respectively, both p<0.001). Heart failure and prior valve surgery also incurred significantly higher reimbursement costs. Prior valve surgery and heart failure were associated with 8.3 (p=0.017) and 5.5 (p=0.021) additional days in hospital, respectively. Conclusions: Financial costs to the NHS from TLE are substantial. Consideration should therefore be given to cost/resource-sparing potential of leadless/extravascular cardiac devices that negate the need for TLE particularly in patients with prior valve surgery and/or heart failure. Additionally, use of antibiotic envelopes and other interventions that reduce infection risk in patients receiving transvenous leads should be considered.

KW - cardiac implantable electronic device complications

KW - cost of lead extraction

KW - transvenous lead extraction

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U2 - 10.1136/heartjnl-2019-315839

DO - 10.1136/heartjnl-2019-315839

M3 - Article

C2 - 31932286

AN - SCOPUS:85077887523

SN - 1355-6037

JO - Heart

JF - Heart

M1 - e2019315839

ER -

Financial and resource costs of transvenous lead extraction in a high-volume lead extraction centre

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