Device Longevity and Survival After Cardiac Resynchronization Therapy Pacemaker (CRT-P) Implantation in the Brazilian Public Health System (SUS): 12-Year Real-World Data Analysis
Author(s)
Miriam A. Marcolino, PhD1, RODRIGO ANTONINI RIBEIRO, MSc, ScD, MD2, Carisi A. Polanczyk, DrPH, ScD, MD2;
1Universidade Federal do Rio Grande do Sul, Graduate Program in Epidemiology, Porto Alegre, Brazil, 2IATS, Porto Alegre, Brazil
1Universidade Federal do Rio Grande do Sul, Graduate Program in Epidemiology, Porto Alegre, Brazil, 2IATS, Porto Alegre, Brazil
Presentation Documents
OBJECTIVES: The monitoring of non-pharmacological health technologies needs to consider more than just its effectiveness, but also its expected durability in the real-world practice. Using routinely collected data from the Public Health System in Brazil (SUS), the aim of our study was to describe the device longevity, survival and device-related hospital expenses after cardiac resynchronization therapy pacemaker (CRT-P) implantation in SUS.
METHODS: Retrospective cohort study based on medical claims and mortality data from the Brazilian Ministry of Health, paired through the VinculaSUS project. Patients submitted to a primary CRT-P implant in SUS from 2008 to 2019 were eligible. Using the patients’ ID, multiple hospital claims were combined into complete hospitalizations and linked to mortality data. Overall survival (OS) and time to first device maintenance (lead or generator replacements/repositioning) and replacement were analyzed by the Kaplan-Meier method. Device-related hospital expenses included the first implant hospitalization and any maintenance or replacement following hospitalization, and values were adjusted for inflation until November 2024.
RESULTS: A total of 3,709 patients were analyzed. With 1,850 deaths, the median OS was 5.88 (95% confidence interval [CI] 5.56, 6.31) years. One-, five-, and ten-year mortality were 17.8%, 45.7%, and 60.3%. Median time to the first device-maintenance procedure was 8.96 (95%CI 7.97, not reached; 2,341 events) years (1-year: 4.3%, 5-year: 16.4%, 10-year: 51.3%). 167 patients were submitted to a new device implantation, with cumulative probability of 2.8% in 1 year, 5.1% in 5, and 7% in 10 years. Median time to replacement was not reached. Total device-related expenses mean ± standard deviation were R$ 27,856.67 ± 13,436.36 (R$ 53,406.97 ± 26,156.43 adjusted for inflation).
CONCLUSIONS: Based on 12-year linked data from the Brazilian SUS’ Information Systems, CRT-P short- and long-term mortality is in line with the observed in other countries. Maintenance and replacement procedures were mostly performed within expected device longevity.
METHODS: Retrospective cohort study based on medical claims and mortality data from the Brazilian Ministry of Health, paired through the VinculaSUS project. Patients submitted to a primary CRT-P implant in SUS from 2008 to 2019 were eligible. Using the patients’ ID, multiple hospital claims were combined into complete hospitalizations and linked to mortality data. Overall survival (OS) and time to first device maintenance (lead or generator replacements/repositioning) and replacement were analyzed by the Kaplan-Meier method. Device-related hospital expenses included the first implant hospitalization and any maintenance or replacement following hospitalization, and values were adjusted for inflation until November 2024.
RESULTS: A total of 3,709 patients were analyzed. With 1,850 deaths, the median OS was 5.88 (95% confidence interval [CI] 5.56, 6.31) years. One-, five-, and ten-year mortality were 17.8%, 45.7%, and 60.3%. Median time to the first device-maintenance procedure was 8.96 (95%CI 7.97, not reached; 2,341 events) years (1-year: 4.3%, 5-year: 16.4%, 10-year: 51.3%). 167 patients were submitted to a new device implantation, with cumulative probability of 2.8% in 1 year, 5.1% in 5, and 7% in 10 years. Median time to replacement was not reached. Total device-related expenses mean ± standard deviation were R$ 27,856.67 ± 13,436.36 (R$ 53,406.97 ± 26,156.43 adjusted for inflation).
CONCLUSIONS: Based on 12-year linked data from the Brazilian SUS’ Information Systems, CRT-P short- and long-term mortality is in line with the observed in other countries. Maintenance and replacement procedures were mostly performed within expected device longevity.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
RWD128
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)