Economic Burden Associated With Cardiac Implantable Electronic Device (CIED) Infections in New South Wales, Australia: A Population-Based Study Using Linked Administrative Data.

Background: Cardiac implantable electronic device (CIED) infections are a serious complication that occurs in ~1%-3% of device recipients. However, data on total healthcare costs associated with CIED infections in Australia are scant. This study aims to comprehensively estimate the total healthcare costs of CIED infections in Australia. Methods: This retrospective cohort study included patients 18+ years diagnosed with CIED infections between July 2017 and September 2022 in New South Wales. Using linked administrative data, costs were estimated for in-hospital care, emergency department visits, outpatient services, Medicare claims, ambulance transport, and dispensed medications in the period from 28 days before to 42 days after CIED infection-related hospitalizations. Results: We identified 726 patients with CIED infections, of whom 233 (32.1%) died during a mean follow-up of 35.6 months. The average treatment costs of $77 746, predominantly driven by hospital expenses (88.3%). Key hospital cost drivers included device type, mechanical ventilation, intensive care unit (ICU) stays, temporary pacing, lengths of stay, high-risk patients, and multiple comorbidities. Patients undergoing complete system removal with reimplantation (31.7% of patients) had the highest costs ($120 792), followed by patients with complete system removal only (15.7%; $98 453), and without system removal (52.6%; $45 649). For patients undergoing complete system removal and/or reimplantation procedures, the cost varied by device type ($90 089 for pacemaker patients, $111 677 for cardiac resynchronization therapy (CRT)-pacemaker, $128 864 for implantable cardiac defibrillators, and $148 888 for CRT-defibrillator patients). Conclusions: Our findings highlight the substantial health care costs associated with CIED infections, with wide variations across patient factors and clinical care pathways.