Ray S G, Griffith M J, Jamieson S, Bexton R S, Gold R G
Department of Cardiology, Northern Regional Cardiothoracic Centre, Freeman Hospital, Newcastle on Tyne.
Br Heart J. 1992 Nov;68(5):531-4. doi: 10.1136/hrt.68.11.531.
The report from the Working Party of the British Pacing and Electrophysiology Group recommends the use of more sophisticated pacemakers in most patients. These proposals were initially circulated in September 1990 and are likely to have major cost implications. Their impact on pacing practice and the immediate costs of pacemaker hardware in the Northern Region were retrospectively audited.
The pacing records of 550 patients undergoing a first pacemaker insertion at the Freeman Hospital between March 1990 and August 1991 were reviewed. The patient's age, indication for pacing, pacing mode, and the cost of generator and lead(s) were recorded. The cost was compared with the costs of pacing with the optimal and alternative modes recommended by the Working Party. The costs were calculated from the actual mean cost of the recommended unit over the 18 month period of study multiplied by the number of patients who would have received that unit.
96% of patients were paced for sinus node dysfunction, atrioventricular block, or atrioventricular block and atrial fibrillation. The mean (SD) ages of patients in each diagnostic group were: sinus node dysfunction 69.4 (14), sinus node disease and atrioventricular block 67.2 (17.6), atrioventricular block 73.9 (12.5), atrial fibrillation and atrioventricular block 74.0 (13.9), and carotid sinus hypersensitivity 74.6 (11.6) years. Over the 18 month audit period there was an increase in physiological pacing. AAI pacing in patients with sinus node dysfunction increased by 100% and DDD pacing in atrioventricular block increased by atrioventricular block increased by 56%. Over the whole 18 month period the adoption of the British Pacing and Electrophysiology Groups optimal recommendations would have increased expenditure on pacemaker hardware in the Northern Region by 94% and the use of the alternative mode would have increased it by 61%. For the last six months alone the excess would be 78% and 48%.
The adoption of the recommendations of the British Pacing and Electrophysiology group in the Northern Region would greatly increase the cost of pacing hardware. The greater part of this increase would be attributable to the routine use of dual chamber pacing in patients with atrioventricular block and the increased use of rate responsive units. The benefits of sophisticated pacing in a predominantly elderly population need to outweigh the disadvantages of the increased cost and complexity of follow up.
英国起搏与电生理学会工作小组的报告建议在大多数患者中使用更先进的起搏器。这些提议最初于1990年9月发布，可能会带来重大的成本影响。我们对其对起搏实践的影响以及北部地区起搏器硬件的直接成本进行了回顾性审计。
回顾了1990年3月至1991年8月期间在弗里曼医院首次植入起搏器的550例患者的起搏记录。记录患者的年龄、起搏指征、起搏模式以及发生器和导线的成本。将该成本与工作小组推荐的最佳和替代模式的起搏成本进行比较。成本是通过研究18个月期间推荐设备的实际平均成本乘以接受该设备的患者数量来计算的。
96%的患者因窦房结功能障碍、房室传导阻滞或房室传导阻滞合并心房颤动而接受起搏治疗。各诊断组患者的平均（标准差）年龄分别为：窦房结功能障碍69.4（14）岁，窦房结疾病合并房室传导阻滞67.2（17.6）岁，房室传导阻滞73.9（12.5）岁，心房颤动合并房室传导阻滞74.0（13.9）岁，颈动脉窦过敏74.6（11.6）岁。在18个月的审计期间，生理性起搏有所增加。窦房结功能障碍患者的AAI起搏增加了100%，房室传导阻滞患者的DDD起搏增加了56%。在整个18个月期间，采用英国起搏与电生理学会的最佳建议将使北部地区起搏器硬件支出增加94%，采用替代模式将使其增加61%。仅在最后六个月，超额支出将分别为78%和48%。
在北部地区采用英国起搏与电生理学会的建议将大大增加起搏硬件的成本。这种增加的很大一部分将归因于房室传导阻滞患者常规使用双腔起搏以及频率应答装置使用的增加。在主要为老年人群中采用先进起搏的益处需要超过成本增加和随访复杂性增加的不利之处。
