Health economic evaluation of single-lead atrial pacing vs. dual-chamber pacing in sick sinus syndrome

Europace. 2014 Jun;16(6):866-72. doi: 10.1093/europace/eut384. Epub 2014 Jan 22.


Aims: 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.

Methods and results: 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.

Conclusion: Dual-chamber pacing is likely to be a cost-effective treatment for sick sinus syndrome patients.

Keywords: Cardiac pacing; Cost-effectiveness; Expected value of perfect information; Multi-state model; Sinus node dysfunction.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cardiac Resynchronization Therapy Devices / economics*
  • Cardiac Resynchronization Therapy Devices / statistics & numerical data
  • Cost-Benefit Analysis / economics
  • Cost-Benefit Analysis / statistics & numerical data
  • Denmark / epidemiology
  • Electrodes, Implanted / economics*
  • Electrodes, Implanted / statistics & numerical data
  • Equipment Design
  • Equipment Failure Analysis
  • Female
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Male
  • Prevalence
  • Risk Assessment
  • Sick Sinus Syndrome / economics*
  • Sick Sinus Syndrome / mortality
  • Sick Sinus Syndrome / prevention & control*
  • Survival Analysis
  • Treatment Outcome