Initial experience with the subcutaneous implantable cardioverter-defibrillator with the real costs of hospitalization analysis in a single Polish center

• Published in: Cardiology journal Vol. 26; no. 4; pp. 360 - 367
• Main Authors: Grabowski, Marcin, Gawałko, Monika, Michalak, Marcin, Cacko, Andrzej, Kowara, Michał, Kołodzińska, Agnieszka, Januszkiewicz, Łukasz, Balsam, Paweł, Vitali Serdoz, Laura, Winter, Joachim, Opolski, Grzegorz
• Format: Journal Article
• Language: English
• Published: Poland Wydawnictwo Via Medica 01.01.2019; Via Medica
• Subjects: Adult; Aged; Cardiology Service, Hospital - economics; Clinical Cardiology; Costs; Death, Sudden, Cardiac - prevention & control; Defibrillators, Implantable - economics; Diagnostic Tests, Routine - economics; Drug Costs; Electric Countershock - adverse effects; Electric Countershock - economics; Electric Countershock - instrumentation; Female; Hospital Costs; Hospitalization; Hospitalization - economics; Humans; Laboratories; Length of Stay - economics; Male; Middle Aged; Operative Time; Patients; Personnel, Hospital - economics; Poland; Postoperative Complications - economics; Postoperative Complications - therapy; Primary Prevention - economics; Risk Factors; Salaries and Fringe Benefits - economics; Secondary Prevention; Time Factors; Treatment Outcome; Poland; primary prevention; procedure cost; secondary prevention; leadless; ventricular arrhythmias; subcutaneous implantable cardioverter-defibrillator
• ISSN: 1897-5593; 1897-5593; 1898-018X
• DOI: 10.5603/CJ.a2018.0024

The recent introduction of an entirely subcutaneous implantable cardioverter-defibril-lator (S-ICD) represents an important progress in the defibrillation technology towards a less invasive approach. This is a single-center observational study of S-ICD implantations in Poland. The S-ICD was implanted in 11 patients with standard indications for an ICD. Patients in whom the device was implanted were evaluated for adverse events and device function at hospital discharge. All hospitalization costs were calculated and summed up for all patients. Costs were divided into following categories: medical materials, pharmaceuticals, operating theatre staff, cardiology depart-ment staff, laboratory tests, non-laboratory tests and additional non-medical costs. The mean age of patients was 51.6 ± 16.4 years, 9 were men and 2 were women. Four pa-tients had atrial fibrillation as the basal rhythm, 1 patient had atrial flutter and 6 patients had sinus rhythm. All patients had at least one condition that precluded the use of a traditional ICD system or the S-ICD was preferred due to other conditions, i.e. a history complicated transvenous ICD therapy (18%), anticipated higher risk of infection (27%), lack or difficult vascular access (18%), young age and anticipated high cumulated risk of lifetime device therapy (36%). The mean duration of the im-plantation procedure was 2 h. One patient developed a postoperative pocket hematoma. Mean total time of hospitalization was 28 (6-92) days. Average cost of hospitalization per patient was 21,014.29 EUR (minimal = 19,332.71 EUR and maximal = 24,824.14 EUR). S-ICD implantation appears to provide a viable alternative to transvenous ICD, espe-cially for patients without pacing requirements.