OBJECTIVES: To describe the cost and length of stay for a pacemaker implantation with epicardial leads or a Micra implantation between 2019 and 2021, from a nationwide study in France.

METHODS: An observational retrospective study was conducted using the French National Hospital Database (PMSI). Adult (≥18) patients with at least one hospital stay for epicardial single-chamber (epiSC) pacemaker or MicraVR device implantation (identified via device LPP codes) between January 1, 2019, and December 31, 2021, were included. Length of stay and costs were described based on the type of implant. There are specific indications for Micra implants or epicardial leads and thus those patients are not directly comparable. As there is some overlap between the indications, it is nevertheless interesting to report both costs.

RESULTS: During the 3 years, a total of 312 patients had received an epiSC, and 2,374 patients had received a MicraVR device, and were included in the study. The mean length of stay was 21.25 days for epiSC patients and 11.34 days for MicraVR patients, including 10.84 days and 5.36 days on average spent in specialized units (reanimation, intensive care (ICU) and/or surveillance units) respectively. The associated average hospitalization cost per patient was 27118€ for epiSC patients, and 18946€ for MicraVR patients, out of which 24.33% and 16.41% were due to the passage through specialized units.

CONCLUSIONS: Patients implanted with an epicardial lead pacemaker or a MicraVR have long hospital stays, including longer ICU stays, and were associated with a high economic burden. This is in line with expectations: in France, patients receive MicraVR or epicardial leads if they have severe conditions and are expected to be costly and have a long hospital stay.