Impact of the recommendations of the British Pacing and Electrophysiology Group on pacemaker prescription and on the immediate costs of pacing in the Northern Region

Ray, Simon; Griffith, Michael; Jamieson, Sheila; Bexton, RS; Gold, Ronald G.

doi:10.1136/hrt.68.11.531

Cited by 43 publications

(13 citation statements)

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“…[47][48][49][50][51][52][53][54][55][56][57][58] One study 54 considered the cost-effectiveness of dual-chamber versus single-chamber atrial pacing, making it the most relevant non-UK economic evaluation. The remaining four studies considered the cost-effectiveness of dual-chamber versus single-chamber VP.…”

Section: Systematic Review Of Existing Cost-effectiveness Evidencementioning

confidence: 99%

“…47,53 A narrative review of these studies is presented in the section Narrative summary of included non-UK economic evaluations, with quality assessment against the NICE reference case and Philips checklist 59 presented in Appendix 3, Quality assessment. The single UK-specific costing study 57 identified in the TAG's systematic review of the economic literature provides information on the cost of devices incurred by a single centre in 1991 and is therefore of limited use to inform an up-to-date economic evaluation.…”

Section: Systematic Review Of Existing Cost-effectiveness Evidencementioning

confidence: 99%

“…The aims of the study carried out by Ray et al 57 were twofold: first, to assess the impact of the 1990 BPEG guidelines on clinical practice and, second, to assess the impact of full guideline adherence on cost. An audit of patients undergoing first pacemaker implant for the period of March 1990 to August 1991 was carried out and these data were used to assess changes in clinical practice and average device costs.…”

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confidence: 99%

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Dual-chamber pacemakers for treating symptomatic bradycardia due to sick sinus syndrome without atrioventricular block: a systematic review and economic evaluation

Edwards¹,

Karner²,

Trevor³

et al. 2015

Health Technol Assess

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BackgroundBradycardia [resting heart rate below 60 beats per minute (b.p.m.)] can be caused by conditions affecting the natural pacemakers of the heart, such as sick sinus syndrome (SSS) and atrioventricular (AV) blocks. People suffering from bradycardia may present with palpitations, exercise intolerance and fainting. The only effective treatment for patients suffering from symptomatic bradycardia is implantation of a permanent pacemaker.ObjectiveTo appraise the clinical effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber atrial pacemakers for treating symptomatic bradycardia in people with SSS and no evidence of AV block.Data sourcesAll databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Health Technology Assessment database, NHS Economic Evaluations Database) were searched from inception to June 2014.MethodsA systematic review of the clinical and economic literature was carried out in accordance with the general principles published by the Centre for Reviews and Dissemination. Randomised controlled trials (RCTs) evaluating dual-chamber and single-chamber atrial pacemakers and economic evaluations were included. Pairwise meta-analysis was carried out. A de novo economic model was developed.ResultsOf 493 references, six RCTs were included in the review. The results were predominantly influenced by the largest trial DANPACE. Dual-chamber pacing was associated with a statistically significant reduction in reoperation [odds ratio (OR) 0.48, 95% confidence interval (CI) 0.36 to 0.63] compared with single-chamber atrial pacing. The difference is primarily because of the development of AV block requiring upgrade to a dual-chamber device. The risk of paroxysmal atrial fibrillation was also reduced with dual-chamber pacing compared with single-chamber atrial pacing (OR 0.75, 95% CI 0.59 to 0.96). No statistically significant difference was found between the pacing modes for mortality, heart failure, stroke, chronic atrial fibrillation or quality of life. However, the risk of developing heart failure may vary with age and device. The de novo economic model shows that dual-chamber pacemakers are more expensive and more effective than single-chamber atrial devices, resulting in a base-case incremental cost-effectiveness ratio (ICER) of £6506. The ICER remains below £20,000 in probabilistic sensitivity analysis, structural sensitivity analysis and most scenario analyses and one-way sensitivity analyses. The risk of heart failure may have an impact on the decision to use dual-chamber or single-chamber atrial pacemakers. Results from an analysis based on age (> 75 years or ≤ 75 years) and risk of heart failure indicate that dual-chamber pacemakers dominate single-chamber atrial pacemakers (i.e. are less expensive and more effective) in older patients, whereas dual-chamber pacemakers are dominated by (i.e. more expensive and less effective) single-chamber atrial pacemakers in younger patients. However, these results are based on a subgroup analysis and should be treated with caution.ConclusionsIn patients with SSS without evidence of impaired AV conduction, dual-chamber pacemakers appear to be cost-effective compared with single-chamber atrial pacemakers. The risk of developing a complete AV block and the lack of tools to identify patients at high risk of developing the condition argue for the implantation of a dual-chamber pacemaker programmed to minimise unnecessary ventricular pacing. However, considerations have to be made around the risk of developing heart failure, which may depend on age and device.Study registrationThis study is registered as PROSPERO CRD42013006708.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Systematic Review Of Existing Cost-effectiveness Evidencementioning

confidence: 99%

Section: Systematic Review Of Existing Cost-effectiveness Evidencementioning

confidence: 99%

mentioning

confidence: 99%

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Dual-chamber pacemakers for treating symptomatic bradycardia due to sick sinus syndrome without atrioventricular block: a systematic review and economic evaluation

Edwards¹,

Karner²,

Trevor³

et al. 2015

Health Technol Assess

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“…2 However, considerable differences have been reported in the frequency of implantation of pacemakers and in the system selected. 3,4 Studies discussing the clinical profile of the patients undergoing pacemaker implantation are available in Western literature, there are not many studies from the India, in view of which we conducted a study to assess clinical profile of the patients undergoing pacemaker implantation.…”

Section: Introductionmentioning

confidence: 99%

Clinical profiles of patients undergoing pacemaker implantation in India

Jain¹

2018

jmscr

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“…4 Relatively little is known about the reasons for these differences. 5 There is some evidence that patients' sex might play a part in clinical decision making. [6][7][8] We used a large database to analyse whether sex can explain differences in the selection of pacemaker systems.…”

Section: Introductionmentioning

confidence: 99%

Science commentary: Pacemakers

Berger¹

1998

BMJ

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Objective: To evaluate the effect of patients' sex on selection of pacemakers. Design: Retrospective univariate and multivariate analysis of a large database. Setting: German central pacemaker register. Subjects: Records collected at the register for 1992 and 1993 (n = 31 913), covering 64% of all implantations in Germany. Main outcome measure: Probability of receiving a single chamber, dual chamber, or rate responsive pacemaker in relation to sex. Results: Univariate analysis showed that women were more likely to receive single chamber pacemakers and less likely to receive dual chamber or rate responsive systems than men. After demographic and clinical variables were controlled for, women were still more likely to receive a single chamber system (atrial pacing: odds ratio 0.89, 95% confidence interval 0.74 to 1.07; ventricular pacing: 0.85, 0.80 to 0.92) and less likely to receive a dual chamber (1.20, 1.12 to 1.30) or a rate responsive system (1.26, 1.17 to 1.37) than men. Conclusions:The data suggest sex differences in the selection of a pacemaker system which cannot be explained by the underlying cardiac disorder. Further research is needed to evaluate why guidelines for implanting pacemakers are not better adhered to.

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Impact of the recommendations of the British Pacing and Electrophysiology Group on pacemaker prescription and on the immediate costs of pacing in the Northern Region

Cited by 43 publications

References 3 publications

Dual-chamber pacemakers for treating symptomatic bradycardia due to sick sinus syndrome without atrioventricular block: a systematic review and economic evaluation

Dual-chamber pacemakers for treating symptomatic bradycardia due to sick sinus syndrome without atrioventricular block: a systematic review and economic evaluation

Clinical profiles of patients undergoing pacemaker implantation in India

Science commentary: Pacemakers

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