de Sousa João, Marques Pedro, Martins Vítor, Hipólito-Reis António, Duarte Luís, Joaquim Inês, Monteiro Diogo, Boriani Giuseppe, Wolff Claudia, Grammatico Andrea, Padeletti Luigi
Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
Hospital Distrital de Santarém, Santarém, Portugal.
Rev Port Cardiol (Engl Ed). 2018 Dec;37(12):973-978. doi: 10.1016/j.repc.2018.01.013. Epub 2018 Dec 7.
The MINERVA trial established that atrial preventive pacing and atrial antitachycardia pacing (DDDRP) in combination with managed ventricular pacing (MVP) reduces progression to permanent atrial fibrillation (AF) in patients with paroxysmal or persistent AF and bradycardia who need cardiac pacing, compared to standard dual-chamber pacing (DDDR). It was shown that AF-related health care utilization was significantly lower in the DDDRP + MVP group than in the control group. Cost analysis demonstrated significant savings related to this new algorithm, based on health care costs from the USA, Italy, Spain and the UK.
To calculate the savings associated with reduced health care utilization due to enhanced pacing modalities in the Portuguese setting.
The impact on costs was estimated based on tariffs for AF-related hospitalizations and costs for emergency department and outpatient visits in Portugal.
The MINERVA trial showed a 42% reduction in AF-related health care utilization thanks to the new algorithm. In Portugal, this represents a potential cost saving of 2323 euros per 100 patients in the first year and 17118 euros over a 10-year period. Considering the number of patients who could benefit from this new algorithm, Portugal could save a total of 75369 euros per year and 555410 euros over 10 years. Additional savings could accrue if heart failure and stroke hospitalizations were considered.
The combination of atrial preventive pacing, atrial antitachycardia pacing and an algorithm to minimize the detrimental effect of right ventricular pacing reduces recurrent and permanent AF. The new DDDRP + MVP pacing mode could contribute to significant costs savings in the Portuguese health care setting.
MINERVA试验证实，对于需要心脏起搏的阵发性或持续性房颤及心动过缓患者，心房预防性起搏和心房抗心动过速起搏（DDDRP）联合管理心室起搏（MVP）与标准双腔起搏（DDDR）相比，可降低永久性房颤（AF）的进展。结果显示，DDDRP + MVP组的房颤相关医疗保健利用率显著低于对照组。基于美国、意大利、西班牙和英国的医疗保健成本进行的成本分析表明，这种新算法可显著节省费用。
计算在葡萄牙环境下，由于起搏方式改进导致医疗保健利用率降低所带来的节省费用。
根据葡萄牙房颤相关住院费用以及急诊科和门诊就诊费用的收费标准估算成本影响。
MINERVA试验表明，新算法使房颤相关医疗保健利用率降低了42%。在葡萄牙，这意味着每100名患者在第一年可节省2323欧元，10年内可节省17118欧元。考虑到可能从这种新算法中受益的患者数量，葡萄牙每年总共可节省75369欧元，10年内可节省555410欧元。如果考虑心力衰竭和中风住院费用，还可进一步节省。
心房预防性起搏、心房抗心动过速起搏以及将右心室起搏的有害影响降至最低的算法相结合，可减少复发性和永久性房颤。新的DDDRP + MVP起搏模式可为葡萄牙医疗保健环境带来显著的成本节省。
