Cost savings associated with extended battery longevity in cardiac resynchronization therapy defibrillators (CRT-D)

Abstract

BackgroundCardiac resynchronization therapy-defibrillators (CRT-D) are devices established as treatment for symptomatic heart failure patients at risk of sudden cardiac death. Battery depletion poses a significant clinical and economic burden; extended service life may reduce costs due to generator changes and associated complications. ObjectiveThis study estimated cost-savings associated with extended battery longevity in Medicare patients receiving CRT-D implantation. MethodsA decision tree was used to explore three battery capacities: 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 6 years, estimated costs included device implantation, replacement, follow-up appointments, and complications. ResultsThe 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, 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 over a 6-year period, the difference in costs between 2.1Ah1.0Ah battery capacity exceeded $500 million. ConclusionExtended longevity CRT-D batteries demonstrate significant cost savings to Medicare over 6 years. These data indicate long-term economic considerations should be included in device selection.