Modelling the health benefits and economic implications of implanting dual-chamber vs. single-chamber ventricular pacemakers in the UK

• DOI: 10.1093/europace/eul042
• Publication Date: 2006-05-12T03:34:33Z
• Authors: Jaime Caro; Alexandra Ward; Jorgen Moller
• Keywords: Single chamber; Artificial cardiac pacemaker

Aims To estimate the consequences of managing bradycardia due to sinoatrial node disease or atrioventricular block with dual-chamber vs. single-chamber ventricular pacemakers. Methods and results A discrete-event simulation was conducted predict outcomes over 5 years. Patients could develop post-operative complications, clinically relevant pacemaker syndrome leading replacement dual-chamber, atrial fibrillation (AF; which if chronic might require anticoagulants) stroke. Survival, quality-adjusted life years (QALYs), associated direct medical costs were estimated (2003 British Pounds £). Identical patients simulated after receiving a device more expensive pacemaker. Probabilities conditions obtained from clinical trials. Benefits discounted at 1.5% 6%. Post-operative complications increased 6.4% 7.7% but AF decreased (22 18%) as did symptoms (16.8 0%). Approximately £4300 accrued per patient Additional health benefits are achieved mean net cost £43 patient, 0.09 QALY cost-effectiveness ratio £477/QALY. Conclusion Implanting costlier increases initial operation; however, this is expected be offset by reduction in re-operations AF.