Cost-effectiveness of dual-chamber pacing compared with ventricular pacing for sinus node dysfunction.

Area of Science:

• Cardiology
• Health Economics
• Medical Technology Assessment

Background:

• Sick sinus syndrome (SSS) patients often require pacemakers.
• Dual-chamber pacing (DCP) offers benefits over single-chamber ventricular pacing (VVI), including improved quality of life.
• The cost-effectiveness of DCP compared to VVI for SSS remains a key consideration.

Purpose of the Study:

• To evaluate the incremental cost-effectiveness of dual-chamber pacing versus ventricular pacing in patients with sick sinus syndrome.
• To project the long-term cost-effectiveness of dual-chamber pacing over a patient's lifetime.

Main Methods:

• Utilized 4-year data from a randomized trial of 2010 patients.
• Employed a Markov model, calibrated with trial data, for lifetime projections.
• Conducted 1000 bootstrap analyses and multiple sensitivity analyses to ensure robustness.

Main Results:

• Dual-chamber pacing demonstrated an incremental cost-effectiveness ratio (ICER) of $53,000 per quality-adjusted year of life (QALY) gained in the initial 4 years.
• Lifetime projections indicated a significant increase in quality-adjusted life expectancy with an ICER of approximately $6,800 per QALY gained.
• Cost-effectiveness was consistently observed across bootstrap and sensitivity analyses, with DCP being cost-effective in over 90% of simulations at common willingness-to-pay thresholds.

Conclusions:

• Dual-chamber pacing is a cost-effective strategy for patients with sick sinus syndrome requiring pacemaker implantation.
• The technology enhances quality-adjusted life expectancy at a generally acceptable cost.
• DCP represents a valuable therapeutic option for improving long-term outcomes in SSS patients.