Cost-effectiveness of dual-chamber pacemaker therapy: Does single lead VDD pacing reduce treatment costs of atrioventricular block?

Abstract

Aims Implantation of single-lead VDD pacemakers is an established alternative to DDD pacing in patients with atrioventricular block. This study compares the long-term costs of both systems. Methods and Results Three hundred and sixty patients with atrioventricular block received VDD or DDD pacemakers in alternating order. Primary costs of implantation included: devices, leads and operation material, surgeons, nurses, medical technicians, and hospitalization. The mean cost of an uncomplicated DDD pacemaker implantation was defined as 1000 virtual cost-units (CU). Costs of pacemaker related complications or re-operations as well as upgrades from VDD to DDD devices were considered secondary costs and assessed during a mean follow-up period of 42 ±15 months. Pacing efficacy was assessed by event-free survival with maintained atrioventricular synchronized pacing mode. Costs of pacemaker devices were not different (639 ±26 CU in VDD vs 641±32 CU in DDD, ns). However, due to lower costs of lead hardware (102 ±10 CU in VDD vs 133± 14 CU in DDD, P<0.001) and shorter implantation procedures (44.3±5.1 min vs 74.4±13.5min, P<0.001), costs of an uncomplicated implantation were 8.9% lower in the VDD group (911±35 CU vs 1000 ±39 CU, P<0.001). A smaller complication rate in the VDD group led to a 16.1% reduction of secondary costs (26 ±17 CU year-1 vs 31 ± 25 CU year-1 , P=0.024). Event-free survival did not differ between groups (83.4% in VDD vs 84.9% in DDD, ns). Conclusion Use of single-lead VDD pacemakers achieves significant reduction of implantation and follow-up costs without loss of therapeutic efficacy compared to conventional DDD systems. © 2001 The European Society of Cardiology.