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Factors Associated with the Treatment Costs within the First Year after Pacemaker Implantation or Pulse Generator
Lucas Bassoli de Oliveira Alves1, Katia Regina Silva1, Jacson Venancio Barros2
1Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.
Insights
Hospital readmissions and complications after pacemaker surgery significantly increase annual treatment costs for the Unified Health System (SUS). Factors like age and comorbidities also impact overall healthcare expenses.
Area of Science:
- Cardiology
- Health Economics
- Public Health
Background:
- The increasing elderly population drives a steady rise in artificial cardiac pacemaker usage.
- Understanding the economic implications of pacemaker procedures is crucial for healthcare system management.
Purpose of the Study:
- To evaluate hospital readmission and complication rates following pacemaker implantation or pulse generator replacement.
- To assess the financial impact of these events on annual treatment costs within the Unified Health System (SUS).
Main Methods:
- A prospective registry collected clinical practice data during initial hospitalization and the first year post-procedure.
- Costs were estimated based on SUS reimbursement values and analyzed at the patient level.
- Generalized linear models identified factors influencing total annual treatment costs (significance level: 5%).
Main Results:
- 1,223 patients (634 initial implants, 589 replacements) were analyzed.
- Complications occurred in 5.1% of patients (70 episodes).
- One-year hospital readmission rates were 16.4% for initial implants and 10.6% for replacements.
- Chronic kidney disease, stroke history, prolonged hospital stays, intensive care needs, complications, and readmissions significantly impacted annual costs.
Conclusions:
- Age, comorbidities, postoperative complications, and hospital readmissions are key drivers of increased annual treatment costs for pacemaker patients.
- These findings underscore the importance of managing patient factors to optimize healthcare resource allocation for pacemaker care.
Background:
The use of artificial cardiac pacemakers has grown steadily in line with the aging population.
Objectives:
To determine the rates of hospital readmissions and complications after pacemaker implantation or pulse generator replacement and to assess the impact of these events on annual treatment costs from the perspective of the Unified Health System (SUS).
Methods:
A prospective registry, with data derived from clinical practice, collected during index hospitalization and during the first 12 months after the surgical procedure. The cost of index hospitalization, the procedure, and clinical follow-up were estimated according to the values reimbursed by SUS and analyzed at the patient level. Generalized linear models were used to study factors associated with the total annual treatment cost, adopting a significance level of 5%.
Results:
A total of 1,223 consecutive patients underwent initial implantation (n=634) or pulse generator replacement (n=589). Seventy episodes of complication were observed in 63 patients (5.1%). The incidence of hospital readmissions within one year was 16.4% (95% CI 13.7% - 19.6%) after initial implants and 10.6% (95% CI 8.3% - 13.4%) after generator replacements. Chronic kidney disease, history of stroke, length of hospital stays, need for postoperative intensive care, complications, and hospital readmissions showed a significant impact on the total annual treatment cost.
Conclusions:
The results confirm the influence of age, comorbidities, postoperative complications, and hospital readmissions as factors associated with increased total annual treatment cost for patients with pacemakers.
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