OBJECTIVES

Coronary artery bypass grafting (CABG) is a common procedure. To maintain patient safety, electrocardiograph (ECG) monitoring is indicated. Reusable ECG leads are standard. Disposable, single-patient use leads are available at higher acquisition cost. Studies show that Kendall DL, a disposable ECG cable & lead system, is associated with significantly fewer leads-off alarms (relative risk 0.71) and surgical site infections (SSI, odds ratio 0.74) compared to reusable leads. We assess whether these clinical benefits result in advantages for Medicare payers.

METHODS

The analysis considers a facility performing 200 CABG procedures annually that transitions completely from reusable ($9 per patient) to disposable ($15 per patient) ECG leads. The mean CABG population is age 73 years and 30% female. The cohort undergoes CABG, recovers in the intensive care unit (ICU), before transfer to the general ward and is discharged to a care facility (25.5%) or home (74.5%). In-hospital, ECG monitoring is used for ≤8 days, with 40.9 leads-off alarms per 100 days. At 90-days post-operation, 5.5% have developed an SSI resulting in increased length of stay, readmission, or outpatient care. The analysis uses a 1-year Markov model with 1-day cycle lengths to 90 days and 90-day cycles thereafter. All costs in 2016 USD.

RESULTS

Annual costs to the payer were $12.2 million. This included 605 ICU days and 9 readmissions due to SSI. With use of disposable leads, total costs by facility were reduced by $16,780. Savings included 3.2 days in the ICU and 2.4 readmissions. Running 2,000 probabilistic sensitivity analyses determined that reductions in costs, ICU days, and readmissions were all significant: 95% credible intervals (CrI) did not cross parity. The median (95% CrI) saving was $16,514 ($48,326 to $5,200).

CONCLUSIONS

Clinical benefits of disposable ECG lead systems likely translate into payer benefits for Medicare patients undergoing CABG.