Ds. Cardinal et al., COST SAVINGS WITH NONTHORACOTOMY IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS, The American journal of cardiology, 78(11), 1996, pp. 1255-1259
We analyzed hospital and physician charges for 99 consecutive patients
who underwent implantable cardioverter-defibrillator (ICD) implantati
on at our institution. Eighteen patients received an epicardial lead s
ystem and 81 were scheduled to receive a nonthoracotomy lead system, t
he generator being implanted either abdominally (n=62) or pectorally (
n=19). The epicardial group had a significantly longer convalescent st
ay (11.6+/-2.5 days; mean+/-SEM) than the abdominal nonthoracotomy gro
up, analyzed by intention to treat (4.6+/-0.5 days) or by treatment re
ceived (3.8+/-0.2 days; p <0.0001). Postoperative stay for the pectora
l group was shorter still (2.9+/-0.4 days; p <0.033). Total charges fo
r the epicardial group were $99,081+/-$25,094, significantly higher th
an those for any of the nonthoracotomy groups (p <0.017). Total charge
s for the pectoral group were $44,128+/-$2,465, significantly less tha
n those for the abdominal nonthoracotomy group, analyzed by intention
to treat ($59,961+/-$1,369; p <0.05) or by treatment received ($56,679
+/-$635; p <0.05). Cost reductions in the nonthoracotomy groups were p
rimarily due to decreased in-hospital convalescence period, lower surg
eon and anesthesiologist fees, and lower procedure-day hospital charge
s in the pectoral group. The use of ICDs with nonthoracotomy leads can
result in significantly shorter in-hospital convalescence and a reduc
tion in total implant-related charges of 40% to 55%. The use of pector
ally implanted ICDs results in further reduction in hospital stay and
further cost reduction of 22% to 26%. The trend coward shorter convale
scent stay without postimplant testing is likely to reduce further the
overall costs of ICD implantation. (C) 1996 by Excerpta Medica, Inc.