title: Effects of enhanced pacing modalities on health care resource utilization and costs in bradycardia patients: An analysis of the randomized MINERVA trial.
abstract: BACKGROUND
  Many patients who suffer from bradycardia and need cardiac pacing also have atrial fibrillation (AF). New pacemaker algorithms, such as atrial preventive pacing and atrial antitachycardia pacing (DDDRP) and managed ventricular pacing (MVP), have been specifically designed to reduce AF occurrence and duration and to minimize the detrimental effects of right ventricular pacing. The randomized MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial established that DDDRP + MVP pacing modality reduced permanent AF in bradycardia patients as compared with standard dual-chamber pacing (DDDR).
  
  
  OBJECTIVE
  The aim of this study was to estimate the cost savings due to lower AF-related health care utilization events based on health care costs from the United States and the European Union.
  
  
  METHODS
  Dual-chamber pacemaker patients with a history of paroxysmal or persistent AF were randomly assigned to receive DDDR (n = 385) or the advanced features (DDDRP + MVP; n = 383). We used published health care costs from the United States and the European Union (Italy, Spain, and the United Kingdom) to estimate the costs associated with AF-related hospitalizations and emergency visits.
  
  
  RESULTS
  The rate of AF-related hospitalizations was significantly lower in the DDDRP + MVP group than in the conventional pacemaker group (DDDR group; 42% reduction; incidence rate ratio 0.58). Similarly, a significant reduction of 68% was observed for AF-related emergency department visits (incidence rate ratio 0.32; P < .001). As a consequence, DDDRP + MVP could potentially reduce health care costs by 40%-44%. Over a ten-year period, the cost savings per 100 patients ranged from $35,702 in the United Kingdom to $121,831 in the United States.
  
  
  CONCLUSIONS
  New pacing algorithms such as DDDRP + MVP used in the MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial successfully reduced AF-related health care utilization, resulting in significant cost savings to payers.
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy. Electronic address: giuseppe.boriani@unibo.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: First Department of Cardiology, Evagelismos General Hospital, Athens, Greece.
authors.forename: Antonis S
authors.initials: AS
authors.lastname: Manolis
authors.affiliation: Kennemer Gasthuis, Haarlem, The Netherlands.
authors.forename: Raymond
authors.initials: R
authors.lastname: Tukkie
authors.affiliation: Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Mont
authors.affiliation: Akademisches Lehrkrankenhaus der Elisabethinen, Linz, Austria.
authors.forename: Helmut
authors.initials: H
authors.lastname: Pürerfellner
authors.affiliation: Cardiology Department, S. Filippo Neri Hospital, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Santini
authors.affiliation: Institute of Cardiology, Maggiore Hospital, Crema, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Inama
authors.affiliation: Cardiology Department, G. Mazzini Hospital, Teramo, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Serra
authors.affiliation: Cardiology Department, Garibaldi Nesima Hospital, Catania, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Gulizia
authors.affiliation: Health Department, Municipal Hospital No 4, Moscow, Russia.
authors.forename: Igor Vasilyevich
authors.initials: IV
authors.lastname: Samoilenko
authors.affiliation: Department of Health Economics, Medtronic, Tolochenaz, Switzerland.
authors.forename: Claudia
authors.initials: C
authors.lastname: Wolff
authors.affiliation: Department of Health Economics, Medtronic Inc., Minneapolis, Minnesota.
authors.forename: Reece
authors.initials: R
authors.lastname: Holbrook
authors.affiliation: Medtronic Clinical Research Institute, Regional Clinical Centre, Rome, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Gavazza
authors.affiliation: Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
mesh_terms: D001281:Atrial Fibrillation / Q000517:prevention & control; D001282:Atrial Flutter / Q000517:prevention & control; D001919:Bradycardia / Q000191:economics* / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D017046:Cost Savings; D005062:European Union; D006295:Health Resources / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D014481:United States
keywords: Atrial fibrillation; Bradycardia; Health care costs; Hospitalization; Pacemaker algorithms; Pacing