Copyright © 2001 by the European Society of Cardiology.
Cost-effectiveness of dual-chamber pacemaker therapy: does single lead VDD pacing reduce treatment costs of atrioventricular block?
a Medical University of Lübeck, Department of Internal Medicine II, Lübeck, Germany
b Department of Finances, Lübeck, Germany
revised January 10, 2000; accepted January 14, 2000
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±26CU in VDD vs 641±32CU in DDD, ns). However, due to lower costs of lead hardware (102±10CU in VDD vs 133±14CU in DDD, P<0·001) and shorter implantation procedures (44·3±5·1min vs 74·4±13·5min, P<0·001), costs of an uncomplicated implantation were 8·9% lower in the VDD group (911±35CU vs 1000±39CU,P <0·001). A smaller complication rate in the VDD group led to a 16·1% reduction of secondary costs (26±17CUyear–1vs 31± 25CUyear–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.
Key Words: Cost-effectiveness, dual-chamber pacing, single-lead VDD pacing, complications
f1 Correspondence: Dr med. Uwe K. H. Wiegand, Medizinische Universität zu Lübeck, Medizinische Klinik II, Ratzeburger Allee 16013538 Lübeck, Germany.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  H. M. Spotnitz Surgical Implantation of Pacemakers and Automatic Defibrillators Card. Surg. Adult, January 1, 2008; 3(2008): 1395 - 1428. [Full Text]
|
|
|
|
 |
|
 M. Kuhne, B. Schaer, C. Kaufmann, N. Moulay, T. Cron, T. Cueni, P. Weiss, C. Schindler, C. Sticherling, and S. Osswald A randomized trial comparing two different approaches of pacemaker selection Europace, December 1, 2007; 9(12): 1185 - 1190. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al. Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association Europace, October 1, 2007; 9(10): 959 - 998. [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al. Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association Eur. Heart J., September 2, 2007; 28(18): 2256 - 2295. [Full Text] [PDF]
|
|
|
|
|
|
I. Zupan, L. Lipar, D. Zizek, W. Boute, M. Vidmar, T. Gabrijelcic, P. Rakovec, and A. Brecelj Retrospective analysis of mode survival, reliability of atrial sensing and incidence of atrial tachyarrhythmias in 307 single-lead VDD pacemaker patients Europace, October 1, 2006; 8(10): 855 - 858. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F Eberhardt, F Bode, H Bonnemeier, F Boguschewski, M Schlei, W Peters, and U K H Wiegand Long term complications in single and dual chamber pacing are influenced by surgical experience and patient morbidity Heart, April 1, 2005; 91(4): 500 - 506. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Brunner, M. Olschewski, A. Geibel, C. Bode, and M. Zehender Long-term survival after pacemaker implantation: Prognostic importance of gender and baseline patient characteristics Eur. Heart J., January 1, 2004; 25(1): 88 - 95. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. M. Spotnitz Pacemakers and Automatic Defibrillators Card. Surg. Adult, January 1, 2003; 2(2003): 1293 - 1326. [Full Text]
|
|
|
|
|
|
S. Pakarinen and L. Toivonen Pre-implant determinants of adequate long-term function of single lead VDD pacemakers Europace, January 1, 2002; 4(2): 137 - 141. [Full Text] [PDF]
|
|