Health economic evaluation of single-lead atrial pacing vs. dual-chamber pacing in sick sinus syndrome

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Abstract

Aims

The recent Danish Multicentre Randomized Trial on Single-Lead Atrial (AAIR) Pacing versus Dual-Chamber (DDDR) Pacing in Sick Sinus Syndrome (DANPACE) suggested DDDR pacing as standard care. However, previous findings supported the routine use of AAIR pacing. This study investigated the cost-effectiveness of DDDR pacing compared with AAIR pacing for sick sinus syndrome.

Methods and results

A decision-analytical model based on patient-level data from three randomized trials was designed from the Danish healthcare system's perspective. The main outcomes were lifetime costs, quality-adjusted lifeyears (QALYs), and net monetary benefit. Quality-adjusted lifeyears were calculated by utilizing community-based preferences. Costs were calculated by utilizing the extensive data on resource consumption, from the DANPACE trial. Data were pooled and adjusted for baseline differences. Dual-chamber pacing was shown to be cost-effective in all the analyses using a willingness-to-pay (WTP) threshold of £20 000/QALY, and most analyses using a WTP of £30 000/QALY. When pooling the data and adjusting for baseline differences, Monte Carlo simulations revealed a 51–71% probability of DDDR pacing being cost-effective at a WTP of £20 000/QALY, and a 42–58% probability at a WTP of £30 000/QALY. Dual-chamber pacing was most likely to be cost-effective among elderly patients with comorbidity. The expected value of perfect information was low and initiation of additional publicly funded Danish trials was discouraged.

Conclusion

Dual-chamber pacing is likely to be a cost-effective treatment for sick sinus syndrome patients.

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