Economic and health consequences of managing bradycardia with dual-chamber compared to single-chamber ventricular pacemakers in Italy.
OBJECTIVE
This study sought to estimate the economic implications of managing bradycardia due to sinoatrial node disease or atrioventricular block with dual compared to single-chamber ventricular pacemakers from an Italian government perspective. Dual-chamber pacemakers lower the risk of developing atrial fibrillation and pacemaker syndrome.


METHODS
A discrete event simulation of a patient's course for 5 years following pacemaker implantation. Each patient may experience the following: complications, pacemaker syndrome, atrial fibrillation, stroke, or death. Risk functions were based on published data from the Canadian Trial of Physiologic Pacing and Mode Selection Trial in Sinus-Node Dysfunction. Identical patients were simulated after receiving a single or dual-chamber pacemaker. Quality-adjusted life-years (QALYs) and direct medical costs were estimated (2004 Euros). Benefits and costs were discounted at 3%.


RESULTS
The model predicts that implanting the dual-chamber device in 1000 patients will prevent 36 patients from developing atrial fibrillation, 168 from developing severe pacemaker syndrome, but will lead to 13 additional hospitalizations with complications over 5 years. Health benefits are achieved at an incremental cost of 23 euros per patient, and 0.09 QALY, yielding an incremental cost-effectiveness ratio of euro 260 euros/QALY. Sensitivity analysis shows that device replacement rates due to pacemaker syndrome have the biggest impact on the final results.


CONCLUSIONS
In the long term, higher initial costs of the dual-chamber device may be offset by a reduction in costs associated with reoperations and atrial fibrillation.
Deniz
Huseyin Baris
HB
Caro Research Institute, Concord, Massachusetts 01742, USA. bdeniz@caroresearch.com
Caro
J Jaime
JJ
Ward
Alexandra
A
Moller
Jorgen
J
Malik
Farzana
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001919:Bradycardia / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000191:economics* / Q000379:methods; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000503:physiopathology*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D010138:Pacemaker, Artificial / Q000191:economics*; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome