Implantable Cardioverter Debrillator Practices and Costs at an Academic Medical Center BRIAN OLSHANSKY, M.D., DEBORAH LOOTS, B.S.* and MARY MCGRORY-USSET, M.B.A.* From Loyola University Medical Center, Maywood, Illinois; and *Medtronic, Inc., Minneapolis, Minnesota ICD Practices and Costs. This study addresses current costs of implanting implantable cardioverter debrillators (ICDs) at one large medical center and documents actual costs using two methodologies. To determine the actual cost of ICD therapy, we studied all ICD implants performed in the procedure room (similar to an electrophysiology laboratory) who met accepted secondary prevention (AVID) indications for a 1-year period at Loyola University Medical Center. The study period coincided with the facility’s shift of this procedure out of the operating room to a procedure room. Costs were analyzed two ways: a cost-based analysis and a cost-to-charge ratio analysis based on the facility’s Medicare Cost Report. Twenty-four patients (14 inpatients and 10 outpatients) met the study inclusion criteria. Length of stay averaged 5.8 days for inpatients and 1.1 days for outpatients. In the cost-based analysis, the mean costs of the ICD implant (device, implant proce- dure, and preimplant and postimplant stay) were $33,509 for inpatient and $28,078 for outpatient implants. In the cost-to-charge ratio analysis, the mean costs for the inpatient hospitalization were $35,623. This is one of the rst studies to document cost of ICD therapy and may serve as a benchmark for other facilities. (J Cardiovasc Electrophysiol, Vol. 12, pp. 162-166, February 2001) implantable cardioverter debrillator, implantable cardioverter debrillator implant, hospital costs, cost analysis, inpatient and outpatient settings, AVID trial Introduction Both implantable cardioverter debrillator (ICD) technology and physician practices have changed con- siderably since the rst human implant in 1980 at the Johns Hopkins University in Baltimore, Maryland. 1 Early ICDs were large and required a thoracotomy and general anesthesia for the placement of patches and wires on the outside of the heart. Implant of these early devices typically required a 3- to 4-week hospitalization and the costs were very high. 2 Decreased device size and the development of leads that could be implanted trans- venously have simplied the implant procedure. Because today’s ICDs are implanted in a pectoral location using local anesthesia or conscious sedation, procedures are done more quickly and reduce stafng needs. The length of the hospitalization also has decreased considerably, with some patients being implanted in an outpatient setting. Loyola University Medical Center in Maywood, Illi- nois, made a policy decision to move nearly all ICD implants from the operating room to a less costly proce- dure room in 1998 to deliver ICD implant care more efciently. This study documents ICD implant practices and resulting actual costs at that academic medical cen- ter, providing a benchmark against which other facilities can measure their own results. Methods To establish the actual cost of ICD therapy at an academic medical center, 24 patients were selected pro- spectively from 59 consecutive patients who underwent initial ICD implantation at Loyola University Medical Center for a 1-year period beginning April 1, 1998. Enrolled patients were required to meet the study selec- tion criteria used for the AVID trial 3 and to have their implant performed in the procedure room rather than the operating room (Table 1). This latter criterion was in- tended to focus on costs and practices associated with the emerging trend of performing implants in procedure rooms or electrophysiology (EP) labs. Twenty of the original 59 initial implant patients failed to meet the AVID inclusion/exclusion criteria. Fifteen patients did Research data collection and manuscript preparation were funded, in part, by Medtronic, Inc. Address for correspondence: Brian Olshansky, M.D., Cardiac Electro- physiology, University of Iowa Hospitals, 200 Hawkins Drive, Iowa City, IA 52242. Fax: 319-356-4552; E-mail: brian-olshansky@ uiowa.edu Manuscript received 7 July 2000; Accepted for publication 13 October 2000. 162 Reprinted with permission from JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Volume 12, No. 2, February 2001 Copyright ©2001 by Futura Publishing Company, Inc., Armonk, NY 10504-0418