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Europace Advance Access originally published online on May 11, 2006
Europace 2006 8(6):449-455; doi:10.1093/europace/eul042
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

PACING/CRT

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

Jaime Caro1,3,*, Alexandra Ward1 and Jorgen Moller2

1 Caro Research Institute, 336 Baker Avenue, Concord, MA 01742, USA ; 2 Caro Research Institute, Eslov, Sweden; 3 Division of General Internal Medicine, Royal Victoria Hospital, McGill University, Montreal, Que., Canada

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 to predict outcomes over 5 years. Patients could develop post-operative complications, clinically relevant pacemaker syndrome leading to replacement of single-chamber with dual-chamber, atrial fibrillation (AF; which if chronic might require anticoagulants) or stroke. Survival, quality-adjusted life years (QALYs), complications, and associated direct medical costs were estimated (2003 British Pounds £). Identical patients were simulated after receiving a single-chamber device or a more expensive dual-chamber pacemaker. Probabilities of conditions were obtained from clinical trials. Benefits were discounted at 1.5% and costs at 6%. Post-operative complications increased from 6.4% with single-chamber to 7.7% with dual-chamber but AF decreased (22 vs. 18%) as did clinically relevant pacemaker symptoms (16.8 vs. 0%). Approximately £4300 were accrued per patient over 5 years. Additional health benefits with dual-chamber are achieved at a mean net cost of £43 per patient, leading to 0.09 QALY with a cost-effectiveness ratio of £477/QALY.

Conclusion Implanting the costlier device increases the cost of the initial operation; however, this is expected to be offset by a reduction in costs associated with re-operations and AF.

Key Words: Dual-chamber pacemaker, Costs, Cost-effectiveness, UK

* Corresponding author. Tel: +1 978 371 1660; fax: +1 978 371 2445. E-mail address: jcaro{at}caroresearch.com


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