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Heart ; 106(12): 931-937, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31932286

RESUMO

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.


Assuntos
Desfibriladores Implantáveis , Remoção de Dispositivo/economia , Recursos em Saúde/economia , Custos Hospitalares , Hospitais com Alto Volume de Atendimentos , Marca-Passo Artificial , Medicina Estatal/economia , Idoso , Dispositivos de Terapia de Ressincronização Cardíaca , Análise Custo-Benefício , Remoção de Dispositivo/efeitos adversos , Feminino , Humanos , Reembolso de Seguro de Saúde , Tempo de Internação/economia , Londres , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/economia , Estudos Prospectivos , Sistema de Registros , Fatores de Tempo , Resultado do Tratamento
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