Boriani Giuseppe, Manolis Antonis S, Tukkie Raymond, Mont Lluis, Pürerfellner Helmut, Santini Massimo, Inama Giuseppe, Serra Paolo, Gulizia Michele, Samoilenko Igor Vasilyevich, Wolff Claudia, Holbrook Reece, Gavazza Federica, Padeletti Luigi
Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy.
First Department of Cardiology, Evagelismos General Hospital, Athens, Greece.
Heart Rhythm. 2015 Jun;12(6):1192-200. doi: 10.1016/j.hrthm.2015.02.017. Epub 2015 Feb 19.
Many patients who suffer from bradycardia and need cardiac pacing also have atrial fibrillation (AF). New pacemaker algorithms, such as atrial preventive pacing and atrial antitachycardia pacing (DDDRP) and managed ventricular pacing (MVP), have been specifically designed to reduce AF occurrence and duration and to minimize the detrimental effects of right ventricular pacing. The randomized MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial established that DDDRP + MVP pacing modality reduced permanent AF in bradycardia patients as compared with standard dual-chamber pacing (DDDR).
The aim of this study was to estimate the cost savings due to lower AF-related health care utilization events based on health care costs from the United States and the European Union.
Dual-chamber pacemaker patients with a history of paroxysmal or persistent AF were randomly assigned to receive DDDR (n = 385) or the advanced features (DDDRP + MVP; n = 383). We used published health care costs from the United States and the European Union (Italy, Spain, and the United Kingdom) to estimate the costs associated with AF-related hospitalizations and emergency visits.
The rate of AF-related hospitalizations was significantly lower in the DDDRP + MVP group than in the conventional pacemaker group (DDDR group; 42% reduction; incidence rate ratio 0.58). Similarly, a significant reduction of 68% was observed for AF-related emergency department visits (incidence rate ratio 0.32; P < .001). As a consequence, DDDRP + MVP could potentially reduce health care costs by 40%-44%. Over a ten-year period, the cost savings per 100 patients ranged from $35,702 in the United Kingdom to $121,831 in the United States.
New pacing algorithms such as DDDRP + MVP used in the MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial successfully reduced AF-related health care utilization, resulting in significant cost savings to payers.
许多患有心动过缓且需要心脏起搏的患者同时患有心房颤动（AF）。新的起搏器算法，如心房预防性起搏、心房抗心动过速起搏（DDDRP）和管理心室起搏（MVP），已专门设计用于减少房颤的发生和持续时间，并将右心室起搏的有害影响降至最低。随机化的“最小化右心室起搏预防房颤和心力衰竭试验”证实，与标准双腔起搏（DDDR）相比，DDDRP+MVP起搏模式可降低心动过缓患者的永久性房颤发生率。
本研究旨在根据美国和欧盟的医疗保健成本，估算因房颤相关医疗保健利用事件减少而节省的成本。
将有阵发性或持续性房颤病史的双腔起搏器患者随机分配接受DDDR（n=385）或先进功能（DDDRP+MVP；n=383）。我们使用美国和欧盟（意大利、西班牙和英国）已公布的医疗保健成本来估算与房颤相关住院和急诊就诊的成本。
DDDRP+MVP组房颤相关住院率显著低于传统起搏器组（DDDR组；降低42%；发病率比0.58）。同样，房颤相关急诊就诊显著减少68%（发病率比0.32；P<0.001）。因此，DDDRP+MVP有可能将医疗保健成本降低40%-44%。在十年期间，每100名患者节省的成本从英国的35702美元到美国的121831美元不等。
在“最小化右心室起搏预防房颤和心力衰竭试验”中使用的DDDRP+MVP等新起搏算法成功降低了房颤相关的医疗保健利用率，为支付方节省了大量成本。
