Greenspon Arnold J, Eby Elizabeth L, Petrilla Allison A, Sohail M Rizwan
Cardiac Electrophysiology Laboratory, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Medtronic, Plc., Mounds View, MN, USA.
Pacing Clin Electrophysiol. 2018 May;41(5):495-503. doi: 10.1111/pace.13300. Epub 2018 Mar 25.
Cardiac implantable electronic device (CIED) infection is a serious adverse event, but there are limited contemporary real-world data on treatment pathways and associated costs in the Medicare population following diagnosis of CIED infection. Hence, this study evaluates postinfection treatment pathways and associated healthcare expenditures and mortality among Medicare fee-for-service beneficiaries with CIED infection.
Retrospective cohort analysis of 5,401 beneficiaries who developed a device-related infection in the year following implantation/upgraded CIED (1/1/2010-12/31/2012). Patients were followed-up to 12 months/death following diagnosis of infection and were divided into mutually exclusive groups based on whether they underwent CIED system removal (Group I), or no CIED system intervention (Group II; IIA with or IIB without infection hospitalization). All-cause healthcare resource utilization/expenditures were also measured.
In the year following infection, 64.1% of patients underwent device extraction, of who 2,109 (39.0%) had their device replaced (Group IA) and 1,355 (25.1%) had their device extracted without replacement (Group IB); 62.2% of patients were hospitalized and 25.3% of patients died. Mean Medicare payments-per-patient for facility-based services by group were: IA = $62,638 (standard deviation [SD]: $46,830), IB = $50,079 (SD: $45,006), IIA = $77,397 (SD: $79,130), and IIB = $22,856 (SD: $31,167).
Hospitalizations were the largest cost driver; infection-related costs, including cost of extraction/replacement, accounted for >50% of expenditures for patients with surgical/hospital intervention. Management of CIED infection in Medicare beneficiaries is associated with high healthcare expenditures in the year following infection. Additional measures to prevent device infection are needed to improve the outcomes and reduce costs in these patients.
心脏植入式电子设备（CIED）感染是一种严重的不良事件，但关于医疗保险人群中CIED感染诊断后的治疗途径及相关费用，目前当代真实世界的数据有限。因此，本研究评估了医疗保险按服务付费受益人群中CIED感染后的感染后治疗途径、相关医疗保健支出及死亡率。
对5401名在植入/升级CIED后一年（2010年1月1日至2012年12月31日）发生与设备相关感染的受益人进行回顾性队列分析。在感染诊断后对患者进行长达12个月的随访或直至死亡，并根据是否进行CIED系统移除（第一组）或未进行CIED系统干预（第二组；第二组A为有或无感染住院，第二组B为无感染住院）将患者分为相互排斥的组。还测量了全因医疗资源利用/支出情况。
在感染后的一年中，64.1%的患者进行了设备取出，其中2109名（39.0%）患者更换了设备（第一组A），1355名（25.1%）患者取出设备后未进行更换（第一组B）；62.2%的患者住院，25.3%的患者死亡。各组基于设施服务的每位患者平均医疗保险支付费用为：第一组A = 62,638美元（标准差[SD]：46,830美元），第一组B = 50,079美元（SD：45,006美元），第二组A = 77,397美元（SD：79,130美元），第二组B = 22,856美元（SD：31,167美元）。
住院是最大的成本驱动因素；与感染相关的成本，包括取出/更换成本，占手术/医院干预患者支出的50%以上。医疗保险受益人群中CIED感染的管理在感染后的一年中与高额医疗保健支出相关。需要采取额外措施预防设备感染，以改善这些患者的治疗结果并降低成本。
