Ukh. Wiegand et al., Cost-effectiveness of dual-chamber pacemaker therapy: does single lead VDDpacing reduce treatment costs of atrioventricular block?, EUR HEART J, 22(2), 2001, pp. 174-180
Aims Implantation of single-lead VDD pacemakers is an established alternati
ve to DDD pacing in patients with atrioventricular block. This study compar
es 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, nu
rses, medical technicians, and hospitalization. The mean cost of an uncompl
icated DDD pacemaker implantation was defined as 1000 virtual cost-units (C
U). Costs of pacemaker related complications or re-operations as well as up
grades from VDD to DDD devices were considered secondary costs and assessed
during a mean follow-up period of 42 +/- 15 months. Pacing efficacy was as
sessed 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 ha
rdware (102 +/- 10 CU in VDD vs 133 +/- 14 CU in DDD, P<0(.)001) and shorte
r 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 vs
31 +/- 25 CU year(-1), P=0(.)024). Event-free survival did not differ betw
een 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 c
ompared to conventional DDD systems.
(C) 2001 The European Society of Cardiology.