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

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 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. (C) 2001 The European Society of Cardiology.