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±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.