OBJECTIVES

Infection is a major complication of cardiac implantable electronic device (CIED) therapy and is associated with significant increases in morbidity, mortality, reoperation and healthcare cost. The rate of CIED implantation is increasing with the rapid aging of patients. However, there is insufficient research on the infection rates and the healthcare cost associated with the use of CIED implantation in Korean patients. The purpose of this study is to estimate the incidence rate of infection after CIED implantation and to analyze the healthcare cost of the infected patients using the National Claims Database

METHODS

We analyzed the adjusted total treatment cost associated with CIED infection in a national wide cohort of 17,109 fee-for-service patients admitted for CIED generator implantation, replacement, or revision between January 1, 2014, and December 31, 2016. CIED infection was defined as either: 1) procedure code for device-related infection and any CIED procedure or removal code; or 2) CIED procedure code along with systemic infection. The infection burden and patient health profile were calculated for each year, and propensity score matching was used to adjust for CIED infection burden between infection and non-infection groups.

RESULTS

The adjusted total healthcare costs with infection were $10,722 to $25,738 depending on CIED type. The largest incremental cost with infection was intensive care and additional use of CIED implant, which accounted for more than 40% of the difference. The adjusted total healthcare costs with non-infection groups were $4,653 to $19,331 depending on CIED type. The adjusted cost with infection was significantly greater for implantable cardioverter defibrillators and cardiac resynchronization therapy than implantable pacemaker.

CONCLUSIONS

Infection associated with CIED procedures resulted in substantial incremental total treatment cost that varied with the CIED type. Almost half of the incremental admission cost was for intensive care and additional implant.