FORECASTING CIED LEAD EXTRACTION DEMAND AND BUDGET IMPACT OF A DEDICATED CLINICAL PATHWAY IN BULGARIA
Author(s)
Georgi Svetoslavov Slavchev, PhD, Adriana Dacheva, MA, PhD, Hristo Krastev, MA, Anita Hristova, MA, Boyan Likomanov, MSc, Slaveyko Djambazov, MBA, PhD.
HTA Ltd, Sofia, Bulgaria.
HTA Ltd, Sofia, Bulgaria.
OBJECTIVES: To develop a locally parameterized predictive model estimating future demand for cardiac implantable electronic device (CIED) and transvenous lead extraction in Bulgaria, and to quantify the budget impact of introducing a dedicated clinical pathway for reimbursement.
METHODS: A Microsoft Excel cohort model was built from the National Health Insurance Fund (NHIF) perspective for 2025-2030. The model combined BG-Pace registry retrospective implantation data by device type (pacemaker, ICD, CRT-P, CRT-D), projected annual implantation growth of 7.5%, local expert estimates of current extraction activity, device lifespan assumptions, patient survival, and published probabilities of infection, recurrent infection, lead failure, and pacemaker-to-ICD upgrade. Base-case extraction volumes were validated through probabilistic sensitivity analysis with 1,000 Monte Carlo simulations, varying input parameters by ±20%. Costs compared current fragmented reimbursement with a proposed dedicated pathway costed using TDABC, local clinical workflow, wage data, and supplier prices for extraction consumables.
RESULTS: The model forecast extractions increasing from 132 in 2025 to 241 in 2030, approximately doubling current expert-reported activity. Sensitivity analysis was consistent with the base case, with deviations between -0.4% and 0.6%. Current practice costs BGN15,891.36 per patient versus BGN10,328.30 for the proposed pathway, saving BGN5,563.06 per extraction. Under current practice, cumulative NHIF expenditure would reach BGN18,004,910.88 over six years. Introducing the dedicated pathway would generate BGN884,526.54 savings in 2026, rising to BGN1,340,697.46 in 2030, with cumulative savings of BGN5,568,623.06 during 2026-2030.
CONCLUSIONS: A locally developed predictive model supports creation of a dedicated Bulgarian clinical pathway for CIED and lead extraction. The model provides transparent demand forecasting, robust uncertainty testing, and evidence of increasing NHIF savings as implantation and extraction volumes rise.
METHODS: A Microsoft Excel cohort model was built from the National Health Insurance Fund (NHIF) perspective for 2025-2030. The model combined BG-Pace registry retrospective implantation data by device type (pacemaker, ICD, CRT-P, CRT-D), projected annual implantation growth of 7.5%, local expert estimates of current extraction activity, device lifespan assumptions, patient survival, and published probabilities of infection, recurrent infection, lead failure, and pacemaker-to-ICD upgrade. Base-case extraction volumes were validated through probabilistic sensitivity analysis with 1,000 Monte Carlo simulations, varying input parameters by ±20%. Costs compared current fragmented reimbursement with a proposed dedicated pathway costed using TDABC, local clinical workflow, wage data, and supplier prices for extraction consumables.
RESULTS: The model forecast extractions increasing from 132 in 2025 to 241 in 2030, approximately doubling current expert-reported activity. Sensitivity analysis was consistent with the base case, with deviations between -0.4% and 0.6%. Current practice costs BGN15,891.36 per patient versus BGN10,328.30 for the proposed pathway, saving BGN5,563.06 per extraction. Under current practice, cumulative NHIF expenditure would reach BGN18,004,910.88 over six years. Introducing the dedicated pathway would generate BGN884,526.54 savings in 2026, rising to BGN1,340,697.46 in 2030, with cumulative savings of BGN5,568,623.06 during 2026-2030.
CONCLUSIONS: A locally developed predictive model supports creation of a dedicated Bulgarian clinical pathway for CIED and lead extraction. The model provides transparent demand forecasting, robust uncertainty testing, and evidence of increasing NHIF savings as implantation and extraction volumes rise.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE159
Topic
Economic Evaluation, Health Policy & Regulatory, Health Service Delivery & Process of Care
Topic Subcategory
Budget Impact Analysis
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas