Recent Temporal Trends In Hospital Costs For Implantable Cardioverter Defibrillators

Abstract

Introduction Since the first implantable cardioverter defibrillator (ICD) in 1980, the technological improvement of this device has been groundbreaking and rapid; 40 years later, these devices are now significantly more compact and are capable of new functions such as anti-tachycardia and biventricular pacing. As the functionality of ICDs has increased, the cost associated with ICDs is potentially problematic for their widespread application. While many studies have prospectively analyzed the cost-effectiveness of ICDs for patients, literature concerning the associated institutional costs is very limited. The associated hospital costs for non-surgical patients who received implantable cardioverter defibrillators at the University of Maryland Medical Center from 2015 to 2019 were reviewed. Methods We performed a retrospective analysis of patients who received an implantable cardioverter defibrillator at the University of Maryland Medical Center between 2015 and 2019. Patients admitted for surgical encounters and those who had received an ICD before November 2015 were excluded. Results A total of 423 patients who received implantable cardioverter defibrillators were reviewed. 118 patients admitted for surgical encounters were excluded and an additional 39 patients admitted before November 2015 were excluded for missing cost data. Of the remaining 267 patients, linear regression was used to compare costs vs. time. Overall cost showed little change during this study period. Mean overall variable cost was $34,003.92 with R2 = 3.2 × 10−5 when trended from 2015 to 2019. Mean supply cost was $21,920.78 with R2 = 0.05. Further analysis of the supply cost showed that the mean ICD cost was $16,142.50 with R2 = 0.056. Mean drug cost was $1,544.31 with R2 = 0.0004. Mean laboratory testing cost was $786.65 with R2 = 0.0023. Mean radiology cost was $1,849.94 with R2 = 0.009. Mean labor costs for nursing and physical/occupational therapy were $7,353.04 with R2 = 0.02 and $1,102.67 with R2 = 0.047, respectively. Conclusion From 2015 to 2019, the overall variable cost, encompassing laboratory testing, pharmaceutical costs, operating room costs, imaging, and labor, for non-surgical patients who received an implantable cardioverter defibrillator has not significantly changed. The variable cost of all types of ICDs has not statistically changed during this timeframe. Initial evaluation of ICD costs showed significantly higher costs before the change in the electronic medical record at the University of Maryland Medical Center due to related changes in cost accounting. While this study was limited by the availability of financial data, detailed longitudinal analysis should provide greater insight into changes in the institutional and corresponding healthcare costs for patients receiving ICDs.