Department of Cardiothoracic Surgery, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Fibigerstræde 11, 9220 Aalborg, Denmark
Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7, 9220 Aalborg, Denmark.
Europace. 2014 Jun;16(6):866-72. doi: 10.1093/europace/eut384. Epub 2014 Jan 22.
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.
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.
Dual-chamber pacing is likely to be a cost-effective treatment for sick sinus syndrome patients.
最近丹麦多中心单导联心房（AAIR）起搏与双腔（DDDR）起搏在病窦综合征（DANPACE）中的随机试验表明，DDDR 起搏作为标准治疗。然而，先前的研究结果支持常规使用 AAIR 起搏。本研究旨在调查病窦综合征患者中 DDDR 起搏与 AAIR 起搏相比的成本效益。
从丹麦医疗保健系统的角度出发，基于三项随机试验的患者水平数据设计了一项决策分析模型。主要结局是终生成本、质量调整生命年（QALYs）和净货币收益。质量调整生命年通过利用社区偏好来计算。成本通过利用 DANPACE 试验的广泛资源消耗数据来计算。对数据进行了汇总，并对基线差异进行了调整。使用愿意支付（WTP）阈值为 20000 英镑/QALY 的成本效益分析，双腔起搏在所有分析中均显示出成本效益，使用 WTP 为 30000 英镑/QALY 的成本效益分析也较多。当对数据进行汇总并对基线差异进行调整时，蒙特卡罗模拟显示，在 WTP 为 20000 英镑/QALY 时，DDDR 起搏有 51-71%的可能性具有成本效益，在 WTP 为 30000 英镑/QALY 时，有 42-58%的可能性具有成本效益。在合并症较多的老年患者中，双腔起搏最有可能具有成本效益。完全信息的期望价值较低，不鼓励启动额外的丹麦公共资助试验。
双腔起搏可能是病窦综合征患者的一种具有成本效益的治疗方法。
