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Less with More: Hospitalization Cost and Event Rates with Quadripolar versus Bipolar CRT‐D System
Author(s) -
CORBISIERO RAFFAELE,
KAZEMIAN PEDRAM,
BHARMI RUPINDER,
SHAH RIDDHI,
MULLER DAVID
Publication year - 2016
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12923
Subject(s) - medicine , reimbursement , cardiac resynchronization therapy , incidence (geometry) , heart failure , cardiology , ejection fraction , emergency medicine , health care , physics , optics , economics , economic growth
Background This is a comparative effectiveness study for cardiac resynchronization therapy defibrillator (CRT‐D) therapy enabled by quadripolar (QUAD) versus bipolar (BIP) left ventricular (LV) leads. Heart failure (HF) hospitalization (HFH) rates, associated costs, and 30‐day readmissions after index HFH were compared. Methods Patients with de novo LV leads implanted as part of a CRT‐D system between January 2011 and August 2013 with ≥1‐year follow‐up were included. Medical history, dates, and locations of HFH were collected thereafter. Patients were divided based on LV lead model: QUAD or BIP. Universal billing records (UB‐04) for each HFH and ICD‐9‐CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnoses/procedure codes were used to classify hospitalizations as HF or non‐HF and calculate concurrent U.S. national‐average medicare reimbursement. Rates, associated payer costs, and 30‐day readmissions were then compared using nonparametric bootstrapping. Results Baseline characteristics (N = 69 QUAD and N = 56 BIP) were similar. The inpatient HFH for the QUAD group (0.20/patient‐year) was lower than the BIP group (0.31/patient‐year, incidence rate ratio [IRR] = 0.62, P = 0.036). The overall HFH rate for the inpatient or outpatient setting for QUAD (0.29/patient‐year) was lower than the BIP group (0.42/patient‐year, IRR = 0.69, P = 0.055). Average cost of HFH in QUAD ($4,428/patient‐year) was lower than BIP ($7,354/patient‐year), a 39.8% cost reduction (P = 0.026). The 30‐day readmission rate was also lower in QUAD compared to BIP (19% vs 28%, IRR = 0.68, P = 0.18). Conclusion This U.S. economic comparative study demonstrated that QUAD exhibited lower postimplant inpatient HFH rates and reduced healthcare utilization compared to BIP systems.