Cost-effectiveness of dual-chamber pacing compared with ventricular pacing for sinus node dysfunction
Compared with single-chamber ventricular pacing, dual-chamber pacing can reduce adverse events and, as a result, improve quality of life in patients paced for sick sinus syndrome. It is not clear, however, how these benefits compare with the increased cost of dual-chamber pacemakers. We used 4-year...
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Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2005-01, Vol.111 (2), p.165-172 |
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creator | RINFRET, Stéphane COHEN, David J LAMAS, Gervasio A FLEISCHMANN, Kirsten E WEINSTEIN, Milton C ORAV, John SCHRON, Eleanor LEE, Kerry L GOLDMAN, Lee |
description | Compared with single-chamber ventricular pacing, dual-chamber pacing can reduce adverse events and, as a result, improve quality of life in patients paced for sick sinus syndrome. It is not clear, however, how these benefits compare with the increased cost of dual-chamber pacemakers.
We used 4-year data from a 2010-patient, randomized trial to estimate the incremental cost-effectiveness of dual-chamber pacing compared with ventricular pacing and then projected these findings over the patients' lifetimes by using a Markov model that was calibrated to the first 5 years of in-trial data. To assess the stability of the findings, we performed 1000 bootstrap analyses and multiple sensitivity analyses. During the first 4 years of the trial, dual-chamber pacemakers increased quality-adjusted life expectancy by 0.013 year per subject at an incremental cost-effectiveness ratio of 53,000 dollars per quality-adjusted year of life gained. Over a lifetime, dual-chamber pacing was projected to increase quality-adjusted life expectancy by 0.14 year with an incremental cost-effectiveness ratio of approximately 6800 dollars per quality-adjusted year of life gained. In bootstrap analyses, dual-chamber pacing was cost-effective in 91.9% of simulations at a threshold of 50,000 dollars per quality-adjusted year of life and in 93.2% of simulations at a threshold of 100,000 dollars. Its cost-effectiveness ratio was also below this threshold in numerous sensitivity analyses that varied key estimates.
For patients with sick sinus syndrome requiring pacing, dual-chamber pacing increases quality-adjusted life expectancy at a cost that is generally considered acceptable. |
doi_str_mv | 10.1161/01.CIR.0000151810.69732.41 |
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We used 4-year data from a 2010-patient, randomized trial to estimate the incremental cost-effectiveness of dual-chamber pacing compared with ventricular pacing and then projected these findings over the patients' lifetimes by using a Markov model that was calibrated to the first 5 years of in-trial data. To assess the stability of the findings, we performed 1000 bootstrap analyses and multiple sensitivity analyses. During the first 4 years of the trial, dual-chamber pacemakers increased quality-adjusted life expectancy by 0.013 year per subject at an incremental cost-effectiveness ratio of 53,000 dollars per quality-adjusted year of life gained. Over a lifetime, dual-chamber pacing was projected to increase quality-adjusted life expectancy by 0.14 year with an incremental cost-effectiveness ratio of approximately 6800 dollars per quality-adjusted year of life gained. In bootstrap analyses, dual-chamber pacing was cost-effective in 91.9% of simulations at a threshold of 50,000 dollars per quality-adjusted year of life and in 93.2% of simulations at a threshold of 100,000 dollars. Its cost-effectiveness ratio was also below this threshold in numerous sensitivity analyses that varied key estimates.
For patients with sick sinus syndrome requiring pacing, dual-chamber pacing increases quality-adjusted life expectancy at a cost that is generally considered acceptable.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.CIR.0000151810.69732.41</identifier><identifier>PMID: 15630030</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Atrial Fibrillation - epidemiology ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiac Pacing, Artificial - economics ; Cardiac Pacing, Artificial - methods ; Cardiology. Vascular system ; Coronary heart disease ; Cost-Benefit Analysis ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Female ; Heart ; Heart Ventricles - physiopathology ; Humans ; Male ; Markov Chains ; Medical sciences ; Mortality ; Orthopedic surgery ; Quality of Life ; Randomized Controlled Trials as Topic ; Sick Sinus Syndrome - physiopathology ; Sick Sinus Syndrome - therapy ; Sinoatrial Node - physiopathology ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Survival Analysis ; Treatment Outcome</subject><ispartof>Circulation (New York, N.Y.), 2005-01, Vol.111 (2), p.165-172</ispartof><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c440t-c763fbc02a81c32fabe484fd459bb4c7573f14b6960b94d0ec8f6cdac009c8263</citedby><cites>FETCH-LOGICAL-c440t-c763fbc02a81c32fabe484fd459bb4c7573f14b6960b94d0ec8f6cdac009c8263</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16603143$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15630030$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>RINFRET, Stéphane</creatorcontrib><creatorcontrib>COHEN, David J</creatorcontrib><creatorcontrib>LAMAS, Gervasio A</creatorcontrib><creatorcontrib>FLEISCHMANN, Kirsten E</creatorcontrib><creatorcontrib>WEINSTEIN, Milton C</creatorcontrib><creatorcontrib>ORAV, John</creatorcontrib><creatorcontrib>SCHRON, Eleanor</creatorcontrib><creatorcontrib>LEE, Kerry L</creatorcontrib><creatorcontrib>GOLDMAN, Lee</creatorcontrib><title>Cost-effectiveness of dual-chamber pacing compared with ventricular pacing for sinus node dysfunction</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Compared with single-chamber ventricular pacing, dual-chamber pacing can reduce adverse events and, as a result, improve quality of life in patients paced for sick sinus syndrome. It is not clear, however, how these benefits compare with the increased cost of dual-chamber pacemakers.
We used 4-year data from a 2010-patient, randomized trial to estimate the incremental cost-effectiveness of dual-chamber pacing compared with ventricular pacing and then projected these findings over the patients' lifetimes by using a Markov model that was calibrated to the first 5 years of in-trial data. To assess the stability of the findings, we performed 1000 bootstrap analyses and multiple sensitivity analyses. During the first 4 years of the trial, dual-chamber pacemakers increased quality-adjusted life expectancy by 0.013 year per subject at an incremental cost-effectiveness ratio of 53,000 dollars per quality-adjusted year of life gained. Over a lifetime, dual-chamber pacing was projected to increase quality-adjusted life expectancy by 0.14 year with an incremental cost-effectiveness ratio of approximately 6800 dollars per quality-adjusted year of life gained. In bootstrap analyses, dual-chamber pacing was cost-effective in 91.9% of simulations at a threshold of 50,000 dollars per quality-adjusted year of life and in 93.2% of simulations at a threshold of 100,000 dollars. Its cost-effectiveness ratio was also below this threshold in numerous sensitivity analyses that varied key estimates.
For patients with sick sinus syndrome requiring pacing, dual-chamber pacing increases quality-adjusted life expectancy at a cost that is generally considered acceptable.</description><subject>Aged</subject><subject>Atrial Fibrillation - epidemiology</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiac Pacing, Artificial - economics</subject><subject>Cardiac Pacing, Artificial - methods</subject><subject>Cardiology. Vascular system</subject><subject>Coronary heart disease</subject><subject>Cost-Benefit Analysis</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Female</subject><subject>Heart</subject><subject>Heart Ventricles - physiopathology</subject><subject>Humans</subject><subject>Male</subject><subject>Markov Chains</subject><subject>Medical sciences</subject><subject>Mortality</subject><subject>Orthopedic surgery</subject><subject>Quality of Life</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Sick Sinus Syndrome - physiopathology</subject><subject>Sick Sinus Syndrome - therapy</subject><subject>Sinoatrial Node - physiopathology</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkN1KxDAQRoMo7rr6ChIEvWtNmjRtvZPiz8KCIHod0mniVtqmJq2yb2_U4uZmSObMN-QgdEFJTKmg14TG5fo5JuHQlObhWRQZS2JOD9CSpgmPeMqKQ7QMQBGFTrJAJ96_h6tgWXqMFjQVjBBGlkiX1o-RNkbD2HzqXnuPrcH1pNoItqqrtMODgqZ_w2C7QTld469m3OLAjq6BqVX_gLEO-6afPO5trXG982bqQ6ztT9GRUa3XZ3Ndodf7u5fyMdo8PazL200EnJMxgkwwUwFJVE6BJUZVmufc1DwtqopDlmbMUF6JQpCq4DXRkBsBtYLwT8gTwVbo6i93cPZj0n6UXeNBt63qtZ28FBnLSZZkAbz5A8FZ7502cnBNp9xOUiJ_JEtCZZAs95Llr2TJaRg-n7dMVafr_ehsNQCXM6A8qNY41UPj95wQhFHO2DegWIc7</recordid><startdate>20050118</startdate><enddate>20050118</enddate><creator>RINFRET, Stéphane</creator><creator>COHEN, David J</creator><creator>LAMAS, Gervasio A</creator><creator>FLEISCHMANN, Kirsten E</creator><creator>WEINSTEIN, Milton C</creator><creator>ORAV, John</creator><creator>SCHRON, Eleanor</creator><creator>LEE, Kerry L</creator><creator>GOLDMAN, Lee</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20050118</creationdate><title>Cost-effectiveness of dual-chamber pacing compared with ventricular pacing for sinus node dysfunction</title><author>RINFRET, Stéphane ; COHEN, David J ; LAMAS, Gervasio A ; FLEISCHMANN, Kirsten E ; WEINSTEIN, Milton C ; ORAV, John ; SCHRON, Eleanor ; LEE, Kerry L ; GOLDMAN, Lee</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c440t-c763fbc02a81c32fabe484fd459bb4c7573f14b6960b94d0ec8f6cdac009c8263</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Aged</topic><topic>Atrial Fibrillation - epidemiology</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiac Pacing, Artificial - economics</topic><topic>Cardiac Pacing, Artificial - methods</topic><topic>Cardiology. Vascular system</topic><topic>Coronary heart disease</topic><topic>Cost-Benefit Analysis</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Female</topic><topic>Heart</topic><topic>Heart Ventricles - physiopathology</topic><topic>Humans</topic><topic>Male</topic><topic>Markov Chains</topic><topic>Medical sciences</topic><topic>Mortality</topic><topic>Orthopedic surgery</topic><topic>Quality of Life</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Sick Sinus Syndrome - physiopathology</topic><topic>Sick Sinus Syndrome - therapy</topic><topic>Sinoatrial Node - physiopathology</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>RINFRET, Stéphane</creatorcontrib><creatorcontrib>COHEN, David J</creatorcontrib><creatorcontrib>LAMAS, Gervasio A</creatorcontrib><creatorcontrib>FLEISCHMANN, Kirsten E</creatorcontrib><creatorcontrib>WEINSTEIN, Milton C</creatorcontrib><creatorcontrib>ORAV, John</creatorcontrib><creatorcontrib>SCHRON, Eleanor</creatorcontrib><creatorcontrib>LEE, Kerry L</creatorcontrib><creatorcontrib>GOLDMAN, Lee</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>RINFRET, Stéphane</au><au>COHEN, David J</au><au>LAMAS, Gervasio A</au><au>FLEISCHMANN, Kirsten E</au><au>WEINSTEIN, Milton C</au><au>ORAV, John</au><au>SCHRON, Eleanor</au><au>LEE, Kerry L</au><au>GOLDMAN, Lee</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost-effectiveness of dual-chamber pacing compared with ventricular pacing for sinus node dysfunction</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2005-01-18</date><risdate>2005</risdate><volume>111</volume><issue>2</issue><spage>165</spage><epage>172</epage><pages>165-172</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Compared with single-chamber ventricular pacing, dual-chamber pacing can reduce adverse events and, as a result, improve quality of life in patients paced for sick sinus syndrome. It is not clear, however, how these benefits compare with the increased cost of dual-chamber pacemakers.
We used 4-year data from a 2010-patient, randomized trial to estimate the incremental cost-effectiveness of dual-chamber pacing compared with ventricular pacing and then projected these findings over the patients' lifetimes by using a Markov model that was calibrated to the first 5 years of in-trial data. To assess the stability of the findings, we performed 1000 bootstrap analyses and multiple sensitivity analyses. During the first 4 years of the trial, dual-chamber pacemakers increased quality-adjusted life expectancy by 0.013 year per subject at an incremental cost-effectiveness ratio of 53,000 dollars per quality-adjusted year of life gained. Over a lifetime, dual-chamber pacing was projected to increase quality-adjusted life expectancy by 0.14 year with an incremental cost-effectiveness ratio of approximately 6800 dollars per quality-adjusted year of life gained. In bootstrap analyses, dual-chamber pacing was cost-effective in 91.9% of simulations at a threshold of 50,000 dollars per quality-adjusted year of life and in 93.2% of simulations at a threshold of 100,000 dollars. Its cost-effectiveness ratio was also below this threshold in numerous sensitivity analyses that varied key estimates.
For patients with sick sinus syndrome requiring pacing, dual-chamber pacing increases quality-adjusted life expectancy at a cost that is generally considered acceptable.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>15630030</pmid><doi>10.1161/01.CIR.0000151810.69732.41</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Aged Atrial Fibrillation - epidemiology Biological and medical sciences Blood and lymphatic vessels Cardiac Pacing, Artificial - economics Cardiac Pacing, Artificial - methods Cardiology. Vascular system Coronary heart disease Cost-Benefit Analysis Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Female Heart Heart Ventricles - physiopathology Humans Male Markov Chains Medical sciences Mortality Orthopedic surgery Quality of Life Randomized Controlled Trials as Topic Sick Sinus Syndrome - physiopathology Sick Sinus Syndrome - therapy Sinoatrial Node - physiopathology Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Survival Analysis Treatment Outcome |
title | Cost-effectiveness of dual-chamber pacing compared with ventricular pacing for sinus node dysfunction |
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