The researchers also noted that prior reports may have overestimated the cost-benefit ratio for some patients. "For example, recent cost-effectiveness analyses of ICD (implantable cardiac device) therapy are based on data from randomized trials that limited enrollment of patients older than 75 years. We believe Medicare beneficiary administrative data is a more appropriate tool to study the financial cost of CIED infections because the majority of CIED are implanted in older individuals."
The authors noted that their study period, 2007, captured more technologically advanced devices and implantation techniques, as well as more current guidelines, so the increased rates of infection can not be chalked up to older, less viable implants or antiquated practices and procedures.
Additionally, they said their cost estimates are probably low because "inpatient physicians' fees and required outpatient care are not captured."
The authors said that some of the added cost might be reduced by better detection.
"Strategies to shorten the time to explantation, including expedited diagnosis, could reduce intensive care expenses," they wrote. Also, patients should be carefully assessed for the requirement of external electrical support following explantation of the infected device, since up to 30% of patients may not require implantation of a new device."
In an accompanying editorial, Ronan Margey, MD, of the division of cardiology at Massachusetts General Hospital called the report "a warning siren to physicians to be sure ICD implantation is appropriate per professional society guidelines and to monitor patients at risk of developing infection closely and intervene promptly."
She added, "Furthermore, prevention is better than cure. To optimize prevention, active surveillance of all potential device recipients both before and after device implantation is essential."