Study: Cost of Permanent Pacemakers for Pediatric Patients Grows After Congenital Heart Surgery

The cost of permanent pacemakers in pediatric individuals who have congenital heart surgery accumulates over their lifespan, causing a substantial financial and health care burden to the patient and their families, according to results of a study published in JAMA Network Open. Reducing the incidence of permanent pacemaker implantation should be a focus of health care professionals, according to the study authors.¹

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According to a study published in Heart Failure Clinical, heart failure (HF) is a major cause of morbidity and mortality for adults with congenital heart disease (CHD), with some of the molecular pathways overlapping. CHD includes all deformities to the heart that exist at birth. Although progress has been made in pediatric populations and the study authors reported that mortality decreases in pediatric individuals, there has been an increase in mortality in adulthood, which is significantly linked with HF.²

Investigators aimed to determine the post-surgery burden of permanent pacemaker implantations in pediatric individuals with heart block. According to the study authors, this study is the first to “assess the direct and indirect medical costs associated with permanent pacemakers incurred over 20 years after implantation.”¹

Data on patients’ medical procedures from the Boston Children’s Hospital’s Heart Center database were used, including information on the patients' ages, procedure dates, length of stay, and attending surgeons. Data were collected from January 1, 1960, to December 31, 2018. Patients had to be aged 4 years or younger at time of the surgery with at least 6 months of follow up data. Investigators noted that the 20-year costs were estimated from 20 selected patients who had 1 clinical course without complications and 20 who did have a clinical course with complications due to limited follow-up data. Analysis was performed from January 1, 2020, to November 30, 2022.¹

There were 28,225 individuals included who underwent 38,723 CHSs, according to the study investigators. Of these individuals, 968 received a permanent pacemaker within 30 days of the surgery. Investigators used data on 255 individuals who were younger than 4 years of age when implantation occurred and had 6 months of follow-up data.¹

The study authors reported that the direct and indirect mean costs for the initial implantation were $108,052 and $7338, respectively.¹ Further, the permanent pacemaker mean costs were $91,653 and $7154, respectively, and permanent pacemaker malfunction costs included $52,720 and $1792, respectively. For the 20-year mean costs of the base analysis, investigators estimated a mean direct cost of $180,664 and mean indirect cost of $15,939.¹

In the selected patient cohort, the annual probabilities of malfunction that required lead or generator replacement and infection were 2% and 0.6%, respectively. Generator change had a probability of 11.2%, according to the results.¹

Furthermore, investigators found that patients in the selected cohort who had no complications had a higher rate of complex lesions than the overall cohort.¹ In a study published in Circulation, for patients with CHD, the highest risk for developing HF was found in those with complex CHD lesions.³ The study authors determined that the mean direct cost for those without complications was $203,767 compared to those with 1 or more complications at $472,774. The mean indirect 20-year costs were $17,478 and $36,429, respectively.¹

The study authors concluded that advancements in surgical technology have made a difference; however, they said the same focus should be given to serious comorbidities and other consequences of lifelong cardiac pacing.¹

References

1. Mondal A, Yoo M, Tuttle S, Mah D, et al. Cost of Pacing in Pediatric Patients With Postoperative Heart Block After Congenital Heart Surgery. JAMA Netw Open. 2023;6(11):e2341174. doi:10.1001/jamanetworkopen.2023.41174
2. Fahed AC, Roberts AE, Mital S, Lakdawala NK. Heart failure in congenital heart disease: a confluence of acquired and congenital. Heart Fail Clin. 2014;10(1):219-227. doi:10.1016/j.hfc.2013.09.017
3. Bergh N, Skoglund K, Fedchenko M, et al. Risk of Heart Failure in Congenital Heart Disease: A Nationwide Register-Based Cohort Study. Circulation. 2023;147(12):982-984. doi:10.1161/CIRCULATIONAHA.122.061546