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Europace Advance Access published online on May 11, 2006
Europace, doi:10.1093/europace/eul042
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© The European Society of Cardiology 2006. All rights reserved
Received July 15, 2004
Accepted February 23, 2006

Article

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

Jaime Caro 1 *, Alexandra Ward 2, and Jorgen Moller 3

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

* To whom correspondence should be addressed.
Jaime Caro, E-mail: jcaro{at}caroresearch.com


  Abstract

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.

Keywords: Dual-chamber pacemaker; Costs; Cost-effectiveness; UK.
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