The Economic Impact of Transvenous Defibrillation Lead Systems

The purpose of this study was to compare implant charges and convalescence for transvenous and epicardial defibrillation systems. Hospital stay, intensive care utilization, professional fees, and hospital bills were compared in 44 patients who underwent implantation of a cardiac defibrillator between September 1991 and May 1993. Twenty-five consecutive patients received an epicardial lead system, while 19 consecutive patients underwent implantation of the entire transvenous defibrillation system in the electrophysiology laboratory. There were no significant differences between the two groups in mean age or left ventricular ejection fraction. There was a significant reduction in postoperative hospital convalescence from 7.2 ± 2.0 days with epicardial systems to 3.1 ± 1.5 days with transvenous systems (P < 0.001). Postoperative intensive care unit stay was significantly reduced with transvenous systems compared with epicardial systems (0.1 ± 0.2 vs 1.5 ± 0.9 days; P < 0.001). Hospital charges were also significantly reduced with the transvenous lead system implants. Mean implant charges were lower with transvenous systems; $32,090 ±$2,620 vs $38,307 ±$2,701 (P < 0.001); convalescence charges were lower: $5,861 ±$5,010 vs $12,447 ±$4,969 (P < 0.001); the total hospital bill was also significantly lower with transvenous systems: $53,459 ±$12,588 vs $71,981 ±$16,172 (P < 0.001). Professional fees for implantation ($4,131 ±$1,724 vs $6,100 ± 0, P < 0.001), convalescence care ($1,258 ±$960 vs $2,846 ±$1,770; P < 0.001), and total professional fees ($12,925 ±$4,772 vs $15,731 ±$4,055, P < 0.05) were lower in the transvenous defibrillation group. In conclusion, transvenous defibrillation lead systems are associated with significantly shorter postoperative recovery and significantly lower hospital and professional charges.