COST-BENEFIT-ANALYSIS OF SINGLE AND DUAL-CHAMBER PACING FOR SICK SINUS SYNDROME AND ATRIOVENTRICULAR-BLOCK - AN ECONOMIC SENSITIVITY ANALYSIS OF THE LITERATURE

The benefits of dual (DDD) over single chamber pacing (WI) have been d emonstrated in haemodynamics, exercise capacity, quality of life and r educed complications in atrioventricular block and sick sinus syndrome . The literature was reviewed to provide complication rates for dual a nd VVI pacing. Cost calculations were based on United Kingdom 1991 pri ces. Over a 10-year period, a computer model calculated the incidence and prevalence of atrial fibrillation, stroke, permanent disability, h eart failure and mortality in six patient categories: sick sinus syndr ome paced WI, sick sinus syndrome upgraded to DDD, sick sinus syndrome paced DDD from outset, atrioventricular block paced VVI and those upg raded to DDD and atrioventricular block paced initially DDD. Calculati ons were based on intention to treat. The 10 year survival with DDD vs VVI pacing was 71% vs 57% in sick sinus syndrome and 61% vs 51%, resp ectively, in atrioventricular block. In both indications the prevalenc e of heart failure in the 10 year survivors was 60% lower with DDD pac ing. In sick sinus syndrome patients paced WI, 36% had severe disabili ty while only 8% experienced this with DDD pacing. For atrioventricula r block the figures were, respectively, 22% vs 3%. The difference in 1 0 year cumulative cost between VVI and DDD is 13 times the purchase pr ice of a VVI pulse generator for sick sinus syndrome and 7 times for a trioventricular block. In the third year after implantation the cumula tive costs of DDD were lower than for VVI for both indications. Dual c hamber pacing for both indications, sick sinus syn drome and atriovent ricular block, is both clinically and cost effective.