Hospital utilisation and the costs associated with complications of ICD implantation in a contemporary primary prevention cohort

DO-IT Investigators, M. van Barreveld*, T. E. Verstraelen, E. Buskens, P. F.H.M. van Dessel, L. V.A. Boersma, P. P.H.M. Delnoy, A. E. Tuinenburg, D. A.M.J. Theuns, P. H. van der Voort, G. P. Kimman, A. H. Zwinderman, A. A.M. Wilde, M. G.W. Dijkgraaf

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

10 Downloads (Pure)


Introduction: Implantation of an implantable cardioverter defibrillator (ICD) is standard care for primary prevention of sudden cardiac death. However, ICD-related complications are increasing as the population of ICD recipients grows. Methods: ICD-related complications in a national DO-IT Registry cohort of 1442 primary prevention ICD patients were assessed in terms of additional use of hospital care resources and costs. Results: During a median follow-up of 28.7 months (IQR 25.2–33.7) one or more complications occurred in 13.5% of patients. A complication resulted in a surgical intervention in 53% of cases and required on average 3.65 additional hospital days. The additional hospital costs were €6,876 per complication or €8,110 per patient, to which clinical re-interventions and additional hospital days contributed most. Per category of complications, infections required most hospital utilisation and were most expensive at an average of €22,892. The mean costs were €5,800 for lead-related complications, €2,291 for pocket-related complications and €5,619 for complications due to other causes. We estimate that the total yearly incidence-based costs in the Netherlands for hospital management of ICD-related complications following ICD implantation for primary prevention are €2.7 million. Conclusion: Complications following ICD implantation are related to a substantial additional need for hospital resources. When performing cost-effectiveness analyses of ICD implantation, including the costs associated with complications, one should be aware that real-world complication rates may deviate from trial data. Considering the economic implications, strategies to reduce the incidence of complications are encouraged.

Original languageEnglish
Number of pages8
JournalNetherlands Heart Journal
Publication statusE-pub ahead of print - 24-Nov-2022


  • Complications
  • Health resources
  • Healthcare costs
  • Implantable cardioverter defibrillator
  • Nationwide registry

Cite this