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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3125 — Increasing Use of Implantable Cardioverter-Defibrillators in the Veterans Health Administration: 2001-2010

Groeneveld PWMedvedeva ERoberts CB, and Richardson D, Philadelphia VAMC;

Objectives:
The Veterans Health Administration (VA) has a large chronic heart failure population, and many of these patients are potential candidates for implantable cardioverter-defibrillators (ICDs). It is uncertain how use of ICDs within the VA has increased during the past decade, and how the increasing use of ICDs has impacted VA healthcare costs.

Methods:
We examined national VA administrative records from 2001-2010 to identify patients undergoing ICD implantation and/or who received ICD continuity care (e.g., routine device interrogation) in the VA. Medicare-VA linked data were used to determine whether Veterans had originally received their ICDs outside of VA. Cost data from the VA's Decision Support System and the VA/Health Economics Resource Center's Average Cost Datasets were used to quantify the cost of defibrillator care for each patient, and these costs were totaled for each year. Costs from 2001-2009 were inflated to 2010 dollars using the consumer price index. Trends in both procedure volume and costs were tested using linear regression models.

Results:
The volume of VA ICD implantations increased from 770 in 2001 to 1759 in 2010 (a 128% increase), although implantation volumes have been stable since 2005. Conversely, the number of Veterans receiving ICD continuity care in the VA continually increased from 5,063 in 2001 to 25,235 in 2010, a 398% increase. Seventy-eight percent of Veterans receiving ICD care in VA originally received their device outside of VA. In 2010, ICD implantation cost was $53 million, while ICD continuity care cost was $126 million.

Implications:
The volume of ICD care in the VA has increased substantially over the past 10 years. In particular, there has been a marked increase in Veterans receiving ICD continuity care. Most Veterans with ICDs in the VA originally received their devices outside VA. The costs of continuity care for ICDs greatly exceed the costs of implantation, and these costs continue to rise as the number of Veterans with ICDs increases.

Impacts:
The cost to VA of ICDs rose sharply from 2001-2010. A sizeable portion of the cost increase is attributable to Veterans who received ICDs outside VA, but who receiving subsequent device continuity care within VA.


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