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Healthcare delivery, economics and global health
Original research
Financial and resource costs of transvenous lead extraction in a high-volume lead extraction centre
  1. Justin Gould1,2,
  2. Baldeep S Sidhu1,2,
  3. Bradley Porter1,2,
  4. Benjamin J Sieniewicz1,2,
  5. Scott Freeman3,
  6. Evelien CJ de Wilt3,
  7. Julia C Glover3,
  8. Reza Razavi1,2,
  9. Christopher A Rinaldi1,2
  1. 1 Cardiology Department, Guy’s and Saint Thomas' NHS Foundation Trust, London, UK
  2. 2 King’s College London, London, UK
  3. 3 Ipsos MORI UK Ltd, London, UK
  1. Correspondence to Dr Justin Gould, Cardiology Department, Guy's and Saint Thomas' NHS Foundation Trust, London SE1 7EH, UK; justin.s.gould{at}kcl.ac.uk

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.

  • transvenous lead extraction
  • cost of lead extraction
  • cardiac implantable electronic device complications
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/heartjnl-2019-315839

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    Footnotes

    • Contributors JG and his coauthors have been involved in the concept/design, data acquisition, data analysis/interpretation, statistics, drafting of the manuscript, response to reviewer comments and approval of submitted version 10.12.19.

    • Funding This analysis was funded by Boston Scientific who have not partaken in the study design, data collection, analysis, interpretation of results, manuscript writing or in the decision to submit the paper for publication.

    • Competing interests This work was supported by Boston Scientific who have not partaken in the study design, data collection, analysis, interpretation of results, manuscript writing or in the decision to submit the paper for publication. The study was supported by the Wellcome/EPSRC Centre for Medical Engineering (WT203148/Z/16/Z). Outside of the submitted work JG has received project funding from Rosetrees Charitable Trust; JG and BP have received fellowship funding from Abbott; BSS has received fellowship funding from Medtronic; and BJS has received support from a British Heart Foundation project grant. In their role as consultant analysts, SF, ECJdW and JCG work with a number of pharmaceutical and medical device companies but have no direct conflicts of interest. CAR receives research funding and/or consultation fees from Abbott, Medtronic, Boston Scientific, Spectranetics and MicroPort outside of the submitted work.

    • Patient consent for publication Not required.

    • Ethics approval The analysis was approved by the investigational review board of Guy’s and St Thomas’ Hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available. The authors do not have permission to share the raw data.