Economic impact of longer battery life of cardiac resynchronization therapy defibrillators in Sweden

Gadler, Fredrik; Ding, Yao; Verin, Nathalie; Bergius, Martin; Miller, Jeffrey D.; Lenhart, Gregory; Russell, MW

doi:10.2147/ceor.s114921

Cited by 11 publications

(4 citation statements)

References 28 publications

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“…CRT-D replacement due to battery depletion is a significant cost-driver for payors 13,20 and a significant complication-driver for patients. 21,22 Landolina et al (2017) found the need for device replacements at 6 years was reduced from 83% to 68% with the use of devices with improved battery longevity.…”

Section: Discussionmentioning

confidence: 99%

“…A Microsoft Excel ® -based economic model was developed in the form of a decision tree to explore the potential cost-savings associated with increased battery longevity. The model was used to estimate the average costs associated with an initial CRT-D implantation and replacements per person over a 6-year follow-up from a Medicare perspective using the model structure developed by Gadler et al 13 This model explored different battery longevities corresponding to three capacities to represent the leading device manufacturers available: 1.0Ah, 1.6Ah, and 2.1Ah. The annual risk of all-cause death, 14,15 device-related complications, 16 and the end of battery life 17 (based on the manufacturer’s longevity estimate) were applied.…”

Section: Methodsmentioning

confidence: 99%

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Cost Savings Associated with Extended Battery Longevity in Cardiac Resynchronization Therapy Defibrillators (CRT-D)

Williams,

Sato,

Jacobsen

2024

Preprint

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Background Cardiac resynchronization therapy-defibrillators (CRT-D) are devices established as treatment for symptomatic heart failure patients with an indication for CRT and at risk of sudden cardiac death. However, battery depletion poses a significant clinical and economic burden; extended service life may reduce costs due to generator changes and associated complications. The purpose of this study was to estimate the potential cost-savings associated with extended battery longevity in a Medicare patient population receiving CRT-D implantation. Methods A decision tree was used to explore three battery capacities, which represent the leading device manufacturers available in the US: 1.0 ampere-hours (Ah), 1.6Ah, and 2.1Ah. Yearly risk of all-cause mortality, device-related complications, and end of battery life were estimated. Over a time horizon of 6 years, estimated costs included device implantation, replacement, follow-up appointments, and complications. Costs were discounted at 3%. Univariate deterministic sensitivity analysis was completed for patient survival, battery survival, complication incidence and costs, procedure costs, and time horizon. Results In the base-case, the average total costs to Medicare over 6 years were $41,527, $48,515, and $56,647 per person (USD 2023) for the 2.1Ah, 1.6Ah, and 1.0Ah devices, respectively. The total per-person replacement cost for the 1.0Ah devices was more than 4 times that of the 2.1Ah devices ($20,126 versus $5,006). When extrapolated to the total number of CRT-D implants each year over a 6-year period, the difference in costs between the extended (2.1Ah) and lowest (1.0Ah) battery capacity exceeded $500 million. Conclusions Extended longevity CRT-D batteries demonstrate significant cost savings to Medicare over 6 years compared to those with lower battery capacity. These data indicate long-term economic considerations should be included in device selection.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Cost Savings Associated with Extended Battery Longevity in Cardiac Resynchronization Therapy Defibrillators (CRT-D)

Williams,

Sato,

Jacobsen

2024

Preprint

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“…7). Improved pulse generator longevity reduces complications and costs and, by implication, enhances patient quality of life [17][18][19][20]. The benefits of extended battery longevity is greatest for CRT-D patients but they also apply to patients with single-and dual-chamber ICDs.…”

Section: Discussionmentioning

confidence: 99%

Reliability and longevity of implantable defibrillators

Hauser

Casey

Gitter

et al. 2021

J Interv Card Electrophysiol

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Purpose We hypothesized that data in manufacturers’ product performance reports (PPRs) can provide clinically valuable ICD and cardiac resynchronization defibrillator (CRT-D) reliability and longevity information. Methods Data were obtained from 2019 PPRs. Kaplan-Meier (K-M) probabilities of freedom from malfunction, normal battery depletion (NBD), and NBD + malfunction were calculated for ICD and CRT-D pulse generators (PGs) with LiMnO2 or LiSVO/CFx batteries marketed in the USA from 2010 to 2019 and compared using the log-rank test. Malfunctions (MAL) included PGs that were found outside specifications. Results Study population included 1,149,803 ICD and CRT-D PGs: Abbott (ABT; 35.1%), Biotronik (BIO; 4.6%), Boston Scientific (BSC; 23.5%), and Medtronic (MDT; 36.9%). Significant differences in reliability (p < 0.001), defined by freedom from MAL, were found between manufacturers; the majority of 6808 MAL occurred in ABT devices (n = 4045; 59.4%), followed by BSC (n = 2384; 35.0%), MDT (n = 338;5.0%), and BIO (n = 41; 0.6%). Battery failure (n = 890; 57.9%) was the most common cause of MAL compromising therapy; analysis of unique ABT battery MAL–indicated problem appeared a year prior to advisory. Significant differences (p < 0.001) in battery longevity, as defined by freedom from NBD, were found between manufacturers. Overall performance (freedom from NBD + MAL) favored BSC for CRT-D PGs and MDT and BIO for ICDs. BSC subcutaneous ICD reliability was inferior to its transvenous ICD (p < 0.001). Conclusion PPRs contain valuable data that can be aggregated and analyzed to inform physicians. Differences in product reliability exist between manufacturers. Battery longevity has improved, but MAL have significantly impacted performance. PPR data may be useful for assessing product problems and new technology.

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“…CRT-D replacement due to battery depletion is a significant cost-driver for payors 21 , 26 and a significant complication-driver for patients. 9 , 18 Landolina et al found the need for device replacements at six years was reduced from 83% to 68% with the use of devices with improved battery longevity from the most recent generation.…”

Section: Discussionmentioning

confidence: 99%

First Demonstration of Cardiac Resynchronization Therapy Defibrillator Service Life Exceeding Patient Survival in a Heart Failure with Reduced Ejection Fraction Cohort

Williams

Harley

Williams

2020

J Innov Cardiac Rhythm Manage.

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The occurrence of patient longevity exceeding implantable cardioverterdefibrillator (ICD) service life has important implications for patient outcomes and the cost of care. Battery capacity as measured in ampere-hours (Ah) is a strong predictor of survival to an elective replacement indicator (ERI) point and 2.1 Ah is the largest-capacity ICD battery in use at our facility. This was a long-term study of ICDs out of service (OOS) in patients with heart failure with reduced ejection fraction who received a 2.1-Ah cardiac resynchronization therapy defibrillator (CRT-D). All 2.1-Ah CRT-D systems implanted (n = 418) from August 1, 2008 through August 31, 2016 were included in this retrospective chart review. The primary endpoint was device OOS due to the battery reaching an ERI point, patient death, infection/ erosion, advisory/recall, heart transplant, or unspecified. The maximum follow-up period was 10.3 years, with a mean follow-up length of 4.7 years. The most common reason for device OOS was patient death (65.6%), with only 5.7% of devices reaching the ERI point during the study. There was a period of OOS acceleration driven numerically by patient death in the sixth to ninth years of follow-up. Male sex, ischemic cardiomyopathy, elevated creatinine level, advanced age, and reduced ejection fraction were associated with OOS (p < 0.05). To our knowledge, this is the first study to report ICD battery life exceeding patient survival in a chronic heart failure cohort. During an accelerated time of CRT-D OOS (when it is expected that ~98% of 1.0-Ah and 1.4-Ah CRT-D systems reach an ERI point), patient death resulted in substantially more device OOS than battery replacement and avoided costs of complications and generator changes. These results help to explain the elevated risks of CRT-D generator changes in shorter-longevity devices.

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Economic impact of longer battery life of cardiac resynchronization therapy defibrillators in Sweden

Cited by 11 publications

References 28 publications

Cost Savings Associated with Extended Battery Longevity in Cardiac Resynchronization Therapy Defibrillators (CRT-D)

Cost Savings Associated with Extended Battery Longevity in Cardiac Resynchronization Therapy Defibrillators (CRT-D)

Reliability and longevity of implantable defibrillators

First Demonstration of Cardiac Resynchronization Therapy Defibrillator Service Life Exceeding Patient Survival in a Heart Failure with Reduced Ejection Fraction Cohort

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