Makino Koji, Mudge Mia, Hill Michelle, Zaunmayr Chelsea, Tilden Dominic
THEMA Consulting Pty Ltd Milsons Point New South Wales Australia.
Medtronic Australasia Pty Ltd Macquarie Park New South Wales Australia.
J Arrhythm. 2024 Sep 27;40(6):1481-1489. doi: 10.1002/joa3.13145. eCollection 2024 Dec.
Micra™ VR Transcatheter Pacing System (Micra VR) is a single-chamber transcatheter leadless pacemaker. Absence of leads and subcutaneous pocket reduces or completely eliminates the risk of complications associated with the conventional transvenous pacemakers (TVPM). When compared with TVPM, the leadless technology provides a quicker postimplantation recovery and causes less cosmetic concerns/discomfort providing better patient experiences in the long run. We performed a modeled cost-utility analysis of Micra VR versus TVPM for the management of patients with bradycardia.
We developed a Markov model comparing Micra VR to TVPM over the device battery life of 17 years. Key data inputs were drawn from the MICRA Coverage with Evidence Development (CED) study. Costs were obtained from Australian sources. The analysis is from the perspective of the Australian healthcare system.
The risks of complications, including device-related events, in real-world clinical practice were relatively low for TVPM. The magnitude of cost savings arising from risk reductions provided by Micra VR was however sizable, offsetting roughly a quarter of its additional device cost. Over the 17-year model period, Micra VR was associated with an estimated incremental cost of A$4277 and an incremental quality-adjusted life years (QALYs) of 0.09 when compared with TVPM, yielding an incremental cost-effectiveness ratio of A$47 379 per QALY gain.
Micra VR is likely to offer a cost-effective alternative to the conventional TVPM technology for the management of patients with bradycardia.
Micra™ VR经导管起搏系统（Micra VR）是一种单腔无导线起搏器。无导线和皮下囊袋可降低或完全消除与传统经静脉起搏器（TVPM）相关的并发症风险。与TVPM相比，无导线技术可使植入后恢复更快，减少美容方面的顾虑/不适，从长远来看能为患者提供更好的体验。我们对Micra VR和TVPM在心动过缓患者管理中的应用进行了模拟成本效益分析。
我们开发了一个马尔可夫模型，比较了Micra VR和TVPM在17年的设备电池寿命期间的情况。关键数据输入来自Micra证据拓展覆盖（CED）研究。成本数据来自澳大利亚。该分析是从澳大利亚医疗保健系统的角度进行的。
在现实世界的临床实践中，TVPM的并发症风险，包括与设备相关的事件，相对较低。然而，Micra VR降低风险所带来的成本节约幅度相当可观，抵消了其大约四分之一的额外设备成本。在17年的模型期内，与TVPM相比，Micra VR估计增加成本4277澳元，增加质量调整生命年（QALY）0.09，每获得一个QALY的增量成本效益比为47379澳元。
对于心动过缓患者的管理，Micra VR可能是传统TVPM技术具有成本效益的替代方案。
