Single-chamber pacemakers: with or without leads? Cost-effectiveness and cost-utility analyses

Abstract

Introduction The evolution in pacemaker technologies has led to improvements in size, weight, functionality, and durability, even as the battery and electrode-based structural configuration has remained essentially the same.

Objective To compare the cost-effectiveness and cost-utility of conventional and leadless pacemakers.

Material and methods We conducted a retrospective observational study of 403 patients randomly implanted with a conventional or leadless pacemaker (1 June 2015–31 January 2020) in the Hospital-University Complex of Santiago de Compostela (Galicia, NW Spain).

Results Conventional and leadless pacemakers were implanted in 244 and 159 patients, respectively. Leadless pacemakers were superior to the conventional pacemakers in terms of both cost-effectiveness and cost-utility, with incremental cost-effectiveness ratios of 6,263.38 euros per gained life year and of 5,210.71 euros per quality-adjusted life year, respectively.

Conclusions Leadless pacemakers have fewer complications than conventional pacemakers and, although the device itself is more expensive, the leadless pacemaker is more cost-effective in around 90% of cases.