Health economic evaluation of single-lead atrial pacing vs. dual-chamber pacing in sick sinus syndrome.
OBJECTIVE
The recent Danish Multicentre Randomized Trial on Single-Lead Atrial (AAIR) Pacing versus Dual-Chamber (DDDR) Pacing in Sick Sinus Syndrome (DANPACE) suggested DDDR pacing as standard care. However, previous findings supported the routine use of AAIR pacing. This study investigated the cost-effectiveness of DDDR pacing compared with AAIR pacing for sick sinus syndrome.


RESULTS
A decision-analytical model based on patient-level data from three randomized trials was designed from the Danish healthcare system's perspective. The main outcomes were lifetime costs, quality-adjusted lifeyears (QALYs), and net monetary benefit. Quality-adjusted lifeyears were calculated by utilizing community-based preferences. Costs were calculated by utilizing the extensive data on resource consumption, from the DANPACE trial. Data were pooled and adjusted for baseline differences. Dual-chamber pacing was shown to be cost-effective in all the analyses using a willingness-to-pay (WTP) threshold of £20,000/QALY, and most analyses using a WTP of £30,000/QALY. When pooling the data and adjusting for baseline differences, Monte Carlo simulations revealed a 51-71% probability of DDDR pacing being cost-effective at a WTP of £20,000/QALY, and a 42-58% probability at a WTP of £30,000/QALY. Dual-chamber pacing was most likely to be cost-effective among elderly patients with comorbidity. The expected value of perfect information was low and initiation of additional publicly funded Danish trials was discouraged.


CONCLUSIONS
Dual-chamber pacing is likely to be a cost-effective treatment for sick sinus syndrome patients.
Department of Cardiothoracic Surgery, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Fibigerstræde 11, 9220 Aalborg, Denmark lars.oddershede@gmail.com.
Lars
L
Oddershede
Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7, 9220 Aalborg, Denmark.
Sam
S
Riahi
Department of Cardiology, Skejby Hospital, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200 Aarhus, Denmark.
Jens Cosedis
JC
Nielsen
Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark.
Søren
S
Hjortshøj
Department of Cardiology, Skejby Hospital, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200 Aarhus, Denmark.
Henning Rud
HR
Andersen
Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Fibigerstræde 11, 9220 Aalborg, Denmark.
Lars
L
Ehlers
D000368:Aged; D000369:Aged, 80 and over; D058409:Cardiac Resynchronization Therapy Devices / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data; D003718:Denmark / Q000453:epidemiology; D004567:Electrodes, Implanted / Q000191:economics* / Q000706:statistics & numerical data; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015995:Prevalence; D018570:Risk Assessment; D012804:Sick Sinus Syndrome / Q000191:economics* / Q000401:mortality / Q000517:prevention & control*; D016019:Survival Analysis; D016896:Treatment Outcome
Cardiac pacing; Cost-effectiveness; Expected value of perfect information; Multi-state model; Sinus node dysfunction