Background

The aim is to report healthcare costs in a nationwide cohort of patients with an implantable cardioverter defibrillator (ICD).

Methods

This real-life longitudinal retrospective cohort study was based on the French National Health Data System and enrolled all adult patients from the general health insurance scheme implanted with an ICD between 2008 and 2011, and followed them until 2018.

Results

Overall, 19,408 patients were included (mean age 63.8, SD 12.4 years, 81.6% males), with cardiac resynchronization therapy (CRTD), single-chamber, and dual-chamber ICD in 42.5%, 29.8%, 27.7% of patients, respectively. After a mean follow-up of 6.6 SD 3.3 years, 9514 patients (49.0%) died, and 8678 patients (44.7%) had their ICD replaced. The total healthcare cost (all diseases and injuries combined) was €15,893/patient-year, of which 32% were estimated to be ICD-related. These ICD-related costs were: the implantation hospital stay (representing 59% of the ICD-related costs), ICD replacement (22%), complications' management (11%), and follow-up (9%). Some health events (e.g., a complication during ICD replacement) were counted in two categories, hence the sum of the proportions is >100%. Being under 55 vs. above 75 years old, being treated for hypertension vs. not treated, and receiving a CRT-D vs. a single-chamber ICD each increased the mean total ICD-related cost per patient by approximately 20%; ICD replacement vs. no replacement increased it by 71%.

Conclusions

Almost two thirds of the total ICD patients' healthcare costs remained not ICD-related. Advancing the understanding of direct and indirect costs may help improving cost-effectiveness of patients' care pathway.

中文翻译：

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植入式心脏复律除颤器接受者的医疗保健费用：对来自法国国家医疗保健数据库的 19,408 名患者进行的真实队列研究

背景

目的是报告全国范围内植入式心脏复律除颤器 (ICD) 患者的医疗保健费用。

方法

这项现实生活中的纵向回顾性队列研究基于法国国家健康数据系统，纳入了 2008 年至 2011 年间植入 ICD 的一般健康保险计划中的所有成年患者，并随访至 2018 年。

结果

总体而言，包括 19,408 名患者（平均年龄 63.8 岁，SD 12.4 岁，81.6% 男性），接受心脏再同步化治疗（CRTD)、单腔和双腔 ICD 分别占 42.5%、29.8%、27.7% 的患者。在平均随访 6.6 SD 3.3 年后，9514 名患者（49.0%）死亡，8678 名患者（44.7%）更换了 ICD。总医疗保健费用（所有疾病和伤害的总和）为 15,893 欧元/患者年，其中 32% 估计与 ICD 相关。这些 ICD 相关费用是：植入住院时间（占 ICD 相关费用的 59%）、ICD 更换（22%）、并发症管理（11%）和随访（9%）。一些健康事件（例如，ICD 更换期间的并发症）被分为两类，因此比例之和>100%。55 岁以下与 75 岁以上，接受高血压治疗与未治疗，接受 CRT-D 与未接受治疗 每个单腔 ICD 使每位患者的平均 ICD 相关总成本增加约 20%；ICD 更换与不更换相比增加了 71%。

结论

几乎三分之二的 ICD 患者的医疗保健费用与 ICD 无关。促进对直接和间接成本的理解可能有助于提高患者护理途径的成本效益。