Incidence and costs of cardiac device infections: retrospective analysis using German health claims data
Abstract
Aim: Estimate incidence and costs of cardiac device infections (CDIs) in Germany. Materials & methods: Patients had an implantable cardioverter defibrillator implanted over 2010–2013 and were followed to December 2014 using German health insurance claims data. A case-controlled analysis was performed using propensity score matching methods. Results: Risk of CDI 12 months post-implant was 3.4% overall, either 2.9% for de novo procedures versus 4.4% for replacement procedures. Mean 3-year incremental expenditure per patient for patients with CDI compared with controls was €31,493 for de novo implant patients and €33,777 for replacement patients. Mean incremental expenditure was €59,419 per patient with a major infection. Conclusion: CDIs are highly expensive to manage, reinforcing the need for strategies to reduce their occurrence.
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References
1.
Raatikainen MJ, Arnar DO, Merkely B, Camm AJ, Hindricks G. Access to and clinical use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology Countries: 2016 report from the European Heart Rhythm Association. Europace 18(Suppl. 3), III1–III79 (2016).
2.
Ponikowski P, Voors AA, Anker SD et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur. J. Heart Fail. 18(8), 891–975 (2016).
3.
Priori SG, Blomström-Lundqvist C, Mazzanti A et al. 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur. Heart J. 36(41), 2793–2867 (2015).
4.
NICE technology appraisal guidance 314, June 2014. Implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure (review of TA95 and TA120). www.nice.org.uk/guidance/ta314
5.
Kusumoto FM, Schoenfeld MH, Wilkoff BL et al. HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm (2017) (Epub ahead of print).
6.
Habib G, Lancellotti P, Antunes MJ et al. 2015 ESC guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur. Heart J. 36(44), 3075–3128 (2015).
7.
Sandoe JA, Barlow G, Chambers JB et al. Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint working party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE). J. Antimicrob. Chemother. 70(2), 325–359 (2015).
8.
Køber L, Thune JJ, Nielsen JC et al. Defibrillator implantation in patients with nonischemic systolic heart failure. N. Engl. J. Med. 375(13), 1221–1230 (2016).
9.
Sridhar AR, Lavu M, Yarlagadda V et al. Cardiac implantable electronic device-related infection and extraction trends in the US. Pacing Clin. Electrophysiol. 40(3), 286–293 (2017).
10.
Sohail MR1, Henrikson CA, Braid-Forbes MJ, Forbes KF, Lerner DJ. Mortality and cost-associated with cardiovascular implantable electronic device infections. Arch. Intern. Med. 171(20), 1821–1828 (2011).
11.
de Bie MK, van Rees JB, Thijssen J et al. Cardiac device infections are associated with a significant mortality risk. Heart Rhythm 9, 494–498 (2012).
12.
Sohail MR, Eby EL, Ryan MP, Gunnarsson C, Wright LA, Greenspon AJ. 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 postimplantation. Circ. Arrhythm Electrophysiol. 9(8), pii, e003929 (2016).
13.
IQWiG Institute for Quality and Efficiency in Healthcare. General Methods. Version 4.2 (2015). www.iqwig.de/download/IQWiG_General_Methods_Version_%204–2_no_longer_valid.pdf
14.
Johnson NL, Crown W, Martin BC, Dormuth CR, Siebert U. Good research practices for comparative effectiveness research: analytic methods to improve causal inference from nonrandomized studies of treatment effects using secondary data sources. Report of the ISPOR Retrospective Database Analysis Task Force – Part III. Value Health 12(8), 1062–1073 (2009).
15.
Pan W, Bai H. Propensity Score Analysis: Fundamentals and Developments. The Guilford Press, NY, USA (2015).
16.
Caliendo M, Kopeinig S. Some practical guidance for the implementation of propensity score matching. J. Econ. Surveys 22(1), 31–72 (2008).
17.
Johansen JB, Jorgensen OD, Moller M et al. Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients. Eur. Heart J. 32, 991–998 (2011).
18.
Romeyer-Bouchard C, Da Costa A, Dauphinot V et al. Prevalence and risk factors related to infections of cardiac resynchronization therapy devices. Eur. Heart J. 31(2), 203–210 (2010).
19.
Ahsan SY, Saberwal B, Lambiase PD et al. A simple infection-control protocol to reduce serious cardiac device infections. Europace 16, 1482–1489 (2014).
20.
Kuehn C, Graf K, Heuer W et al. Economic implications of infections of implantable cardiac devices in a single institution. Eur. J. Cardiothorac. Surg. 37(4), 875–879 (2010).
21.
Polyzos KA, Konstantelias AA, Falagas ME. Risk factors for cardiac implantable electronic device infection: a systematic review and meta-analysis. Europace 17(5), 767–777 (2015).
22.
de Oliveira JC, Martinelli M, Nishioka SA et al. Efficacy of antibiotic prophylaxis before the implantation of pacemakers and cardioverter-defibrillators: results of a large, prospective, randomized, double-blinded, placebo-controlled trial. Circ. Arrhythm. Electrophysiol. 2, 29–34 (2009).
23.
Deharo JC, Quatre A, Mancini J et al. Long-term outcomes following infection of cardiac implantable electronic devices: a prospective matched cohort study. Heart 98, 724–731 (2012).
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© 2017 Future Medicine Ltd.
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Received: 1 October 2017
Accepted: 30 October 2017
Published online: 14 November 2017
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Incidence and costs of cardiac device infections: retrospective analysis using German health claims data. (2017) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2017-0080
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