Objective:The paper evaluates the economic burden of implantable cardioverter-defibrillator (ICD) implantation in patients with heart failure (HF) in Xinjiang under DRG reform and centralized procurement of medical consumables, and to analyze disparities between health insurance schemes. Methods:We retrospectively analyzed 975 patients undergoing first-time ICD implantation at a tertiary hospital in Xinjiang, China, from 2021 to 2025. Regression models were used to assess determinants of inpatient costs, out-of-pocket (OOP) proportion, and high medical burden (OOP > 50000 yuan). Results:The median total inpatient cost was 130200 yuan, with medical consumables accounting for 72.5%. The median OOP proportion was higher in the Urban and Rural Resident Basic Medical Insurance (URRBMI) than in the Employees’ Basic Medical Insurance (EBMI) (0.30 vs 0.20, P<0.001). In multivariable logistic regression, URRBMI was associated with a higher risk of high medical burden compared with UEBMI (OR=2.34, 95% CI: 1.45-3.78), and subcutaneous ICD (S-ICD) further increased the risk (OR=3.50, 95% CI: 1.42-8.60). During follow-up, the all-cause readmission rate was 43.9%, and the median readmission cost was 10100 yuan. Conclusions:The cost of ICD implantation for HF patients in Xinjiang is primarily composed of consumable expenses, and marked disparities in OOP burden exist across insurance schemes in Xinjiang, and high-cost cardiac devices/consumables such as S-ICD may further amplify the economic burden among URRBMI beneficiaries. It is recommended to continue promoting regional centralized procurement of high-cost consumables and refining DRG payment standards, while exploring refined payment mechanisms such as payment exclusion for consumables or case-by-case special review. Meanwhile, efforts should be accelerated to establish post-implantation programming and remote monitoring of ICD as medical service items, with clear charging and regulatory standards, and to promote their inclusion into the scope of medical insurance coverage in accordance with regulations, so as to facilitate full-cycle standardized management and reduce the risk of readmission.
Key words
heart failure /
implantable cardioverter-defibrillator /
medical insurance payment method reform /
economic burden of disease /
real-world study
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