The impact of chronic kidney disease on healthcare utilization and costs associated with pacemaker infection

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Abstract Background Patients with CKD are at increased risk of bleeding and device-related infections due to their chronic illness. CKD complicates treatment which could lead to an increase in duration of hospitalizations and higher costs. Purpose The goal of this study is to compare hospitalizations and the total costs associated with permanent pacemaker (PPM) infection in patients with and without CKD. Methods This retrospective analysis used Medicare Fee for service (FFS) claims to identify patients implanted with a transvenous PPM from June 2016-December 2020. Device infections, hospitalizations and costs were identified in a 12-month follow-up period post-device implant. Costs include all inpatient and outpatient hospital costs. Patients with CKD and infections were identified based on ICD-10 diagnostic codes. A generalized linear model was utilized to calculate non-infection and infection costs by CKD status. The simple differences between these cohorts represent the total infection cost with CKD and total infection cost without CKD highlighting the incremental cost of infected patients with CKD. Results A total of 439,679 Medicare FFS patients had PPM insertion from June 2016-December 2020, of which 13% had CKD and 1.2% had a device infection within 12-months post-implant. Infected patients with CKD incurred two admissions on average (p-value = <0.001), versus 1.4 (p-value = <0.001) for an infected patient without CKD. The total days in hospital for infected patients with CKD were 32 days (p-value = <0.001) versus 22 days (p-value=<0.001) for infected patients without CKD (Figure 1). The average cost of an infection in the US for a CKD patient was $176,483 (p-value = <0.001) versus $65,792 (p-value =<0.001) for a patient without CKD. The incremental costs of an infection in CKD as compared to no CKD was $110,691 (p-value of interaction = 0.0160). Conclusion In our analysis PPM-related infection in patients with CKD were characterized by more health care utilizations and higher costs compared to patients without CKD.Figure 1

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