Economic Implications of Longer Battery Longevity of Cardiac Resynchronization Therapy Defibrillator Devices in the United States

Abstract

Introduction The economic impact of generator longevity differs by indicated patient population, as the magnitude of Cardiac Resynchronization Therapy Defibrillator devices (CRT-Ds) survival benefit varies by indication and so does the expected survival of the patient. The objective of this study is to understand cost savings associated with incremental years of battery life from a U.S. payer perspective. Methods Patient data from 7 prospective trials were used to project expected patient survival. Weibull/Gompertz statistical models were fitted to data from: (a) InSync III Marquis, MIRACLE, MIRACLE ICD, PROSPECT and Adaptive CRT for Class III/IV patients, (b) REVERSE for Class II patients, and (c) BLOCK-HF for AV Block patients. Mean battery longevity scenarios used half-yearly increments. A payer perspective based on the 2018 U.S. Centers for Medicare and Medicaid Services (CMS) Medicare program was used. Results Testing mean battery scenarios from 5.5 to 8.5 years, 6 additional months of device longevity result in average Medicare savings of $2,692 for Class III/IV patients, $5,429 for Class II patients and $3,754 for AV Block patients. Additional economic benefits associated with avoiding changeout-related complications were not included in these device cost projections. Conclusions Increasing CRT-D battery life can result in reductions in device-related cost across all indicated patient groups, with economic benefits being maximized among NYHA Class II subjects. But the relative impact lessens as additional battery years are added.