Background Cardiac resynchronization therapy-defibrillators (CRT-D) are devices established as treatment for symptomatic heart failure patients with an indication for CRT and at risk of sudden cardiac death. However, battery depletion poses a significant clinical and economic burden; extended service life may reduce costs due to generator changes and associated complications. The purpose of this study was to estimate the potential cost-savings associated with extended battery longevity in a Medicare patient population receiving CRT-D implantation. Methods A decision tree was used to explore three battery capacities, which represent the leading device manufacturers available in the US: 1.0 ampere-hours (Ah), 1.6Ah, and 2.1Ah. Yearly risk of all-cause mortality, device-related complications, and end of battery life were estimated. Over a time horizon of 6 years, estimated costs included device implantation, replacement, follow-up appointments, and complications. Costs were discounted at 3%. Univariate deterministic sensitivity analysis was completed for patient survival, battery survival, complication incidence and costs, procedure costs, and time horizon. Results In the base-case, the average total costs to Medicare over 6 years were $41,527, $48,515, and $56,647 per person (USD 2023) for the 2.1Ah, 1.6Ah, and 1.0Ah devices, respectively. The total per-person replacement cost for the 1.0Ah devices was more than 4 times that of the 2.1Ah devices ($20,126 versus $5,006). When extrapolated to the total number of CRT-D implants each year over a 6-year period, the difference in costs between the extended (2.1Ah) and lowest (1.0Ah) battery capacity exceeded $500 million. Conclusions Extended longevity CRT-D batteries demonstrate significant cost savings to Medicare over 6 years compared to those with lower battery capacity. These data indicate long-term economic considerations should be included in device selection.

Dr. Williams is a paid consultant to Boston Scientific, but there was no compensation involved in this research. Ryoko Sato and Dr. Caroline Jacobsen are employed by Boston Scientific, which manufactures CRT-D.

No external funding was received.

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On July 8, 2022, WCG IRB approved a request for a waiver of authorization for use and disclosure of protected health information (PHI) for the above-referenced research.

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The data that support the findings of this study are available on request from the corresponding author.