Single-chamber and dual-chamber cardiac pacemakers. A formal cost comparison.
Dual-chamber pacemakers, more sophisticated and costly than single-chamber pacemakers, are being used with increasing frequency, often with unclear indications. Proponents of dual-chamber devices have focused on initial differences in cost without considering additional induced costs. We examined the incremental cost of dual-versus single-chamber pacemakers over the expected lifetime of a pacemaker recipient. In addition to initial costs, we included the costs of pacemaker malfunction, reimplantation, generator replacement, and follow-up. Expected differences in cumulative costs per patient were calculated over a 12-year period. Dual-chamber pacing is $2500 more costly at implantation. The difference in cumulative cost increases to $5100 by year 12, reflecting shorter functional life for dual-chamber pacemaker generators and increased cost of follow-up. The incremental cost of dual-chamber pacemaking is neither short-term nor trivial. Dual-chamber pacemakers should be reserved for those who clearly benefit from its advanced technology.
D003365:Costs and Cost Analysis; D004868:Equipment Failure / Q000191:economics; D006325:Heart Atria; D006352:Heart Ventricles; D006801:Humans; D010138:Pacemaker, Artificial / Q000009:adverse effects / Q000191:economics*; D012086:Reoperation / Q000191:economics; D013997:Time Factors