Cost implications of the British Pacing and Electrophysiology Group's recommendations for pacing.
OBJECTIVE
To compare present pacing practice with the recommendations recently published by the British Pacing and Electrophysiology Group and to assess the increase in annual budget required to implement these recommendations in a regional cardiothoracic unit.


METHODS
Retrospective analysis of pacemaker implantation for 1991 with calculation of the costs required to implement the group's recommendations based on average 1991 costs of the types of pacing generators and electrode leads used.


METHODS
Regional cardiothoracic unit for South West Thames Health Authority.


METHODS
433 consecutive patients receiving permanent pacemaker generators: 76 (18%) with sinus node disease; 270 (62%) with atrioventricular block; 25 (6%) with both sinus node disease and atrioventricular block; 59 (14%) with chronic atrial fibrillation and atrioventricular block; and 3 (1%) with carotid sinus or malignant vasovagal syndromes.


RESULTS
Only 102 (24%) patients received pacemaker generators recommended by the British Pacing and Electrophysiology Group; however, 355 (82%) patients were older than 65 years, and 264 (61%) were aged 75 or over. The cost of hardware for pacing was 462,885 pounds. Using generators as recommended would have cost 810,525 pounds for "optimal" systems (an increase of 75%) and 710,750 pounds for "alternative" systems (an increase of 54%). These increases would have been considerably reduced by limiting the use of sophisticated pacing to younger patients (aged under 75). Further savings could be made by using the least expensive pacing models available.


CONCLUSIONS
Implementing these recommendations should reduce morbidity related to bradyarrhythmia but will lead to major increases in pacing costs. Age and patients' expected activity may be used to select simple pacing systems and thus to contain cost. More research is needed to determine which patient groups will benefit most from complex pacing systems.
de Belder
M A
MA
Regional Cardiothoracic Unit, St George's Hospital, London.
Linker
N J
NJ
Jones
S
S
Camm
A J
AJ
Ward
D E
DE
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies