Giuseppe Boriani1, Antonis S Manolis2, Raymond Tukkie3, Lluis Mont4, Helmut Pürerfellner5, Massimo Santini6, Giuseppe Inama7, Paolo Serra8, Michele Gulizia9, Igor Vasilyevich Samoilenko10, Claudia Wolff11, Reece Holbrook12, Federica Gavazza13, Luigi Padeletti14. 1. Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy. Electronic address: giuseppe.boriani@unibo.it. 2. First Department of Cardiology, Evagelismos General Hospital, Athens, Greece. 3. Kennemer Gasthuis, Haarlem, The Netherlands. 4. Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain. 5. Akademisches Lehrkrankenhaus der Elisabethinen, Linz, Austria. 6. Cardiology Department, S. Filippo Neri Hospital, Rome, Italy. 7. Institute of Cardiology, Maggiore Hospital, Crema, Italy. 8. Cardiology Department, G. Mazzini Hospital, Teramo, Italy. 9. Cardiology Department, Garibaldi Nesima Hospital, Catania, Italy. 10. Health Department, Municipal Hospital No 4, Moscow, Russia. 11. Department of Health Economics, Medtronic, Tolochenaz, Switzerland. 12. Department of Health Economics, Medtronic Inc., Minneapolis, Minnesota. 13. Medtronic Clinical Research Institute, Regional Clinical Centre, Rome, Italy. 14. Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy.
Abstract
BACKGROUND:Many patients who suffer from bradycardia and need cardiac pacing also have atrial fibrillation (AF). New pacemaker algorithms, such as atrial preventive pacing and atrial antitachycardia pacing (DDDRP) and managed ventricular pacing (MVP), have been specifically designed to reduce AF occurrence and duration and to minimize the detrimental effects of right ventricular pacing. The randomized MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial established that DDDRP + MVP pacing modality reduced permanent AF in bradycardia patients as compared with standard dual-chamber pacing (DDDR). OBJECTIVE: The aim of this study was to estimate the cost savings due to lower AF-related health care utilization events based on health care costs from the United States and the European Union. METHODS:Dual-chamber pacemaker patients with a history of paroxysmal or persistent AF were randomly assigned to receive DDDR (n = 385) or the advanced features (DDDRP + MVP; n = 383). We used published health care costs from the United States and the European Union (Italy, Spain, and the United Kingdom) to estimate the costs associated with AF-related hospitalizations and emergency visits. RESULTS: The rate of AF-related hospitalizations was significantly lower in the DDDRP + MVP group than in the conventional pacemaker group (DDDR group; 42% reduction; incidence rate ratio 0.58). Similarly, a significant reduction of 68% was observed for AF-related emergency department visits (incidence rate ratio 0.32; P < .001). As a consequence, DDDRP + MVP could potentially reduce health care costs by 40%-44%. Over a ten-year period, the cost savings per 100 patients ranged from $35,702 in the United Kingdom to $121,831 in the United States. CONCLUSION: New pacing algorithms such as DDDRP + MVP used in the MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial successfully reduced AF-related health care utilization, resulting in significant cost savings to payers.
RCT Entities:
BACKGROUND: Many patients who suffer from bradycardia and need cardiac pacing also have atrial fibrillation (AF). New pacemaker algorithms, such as atrial preventive pacing and atrial antitachycardia pacing (DDDRP) and managed ventricular pacing (MVP), have been specifically designed to reduce AF occurrence and duration and to minimize the detrimental effects of right ventricular pacing. The randomized MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial established that DDDRP + MVP pacing modality reduced permanent AF in bradycardiapatients as compared with standard dual-chamber pacing (DDDR). OBJECTIVE: The aim of this study was to estimate the cost savings due to lower AF-related health care utilization events based on health care costs from the United States and the European Union. METHODS: Dual-chamber pacemaker patients with a history of paroxysmal or persistent AF were randomly assigned to receive DDDR (n = 385) or the advanced features (DDDRP + MVP; n = 383). We used published health care costs from the United States and the European Union (Italy, Spain, and the United Kingdom) to estimate the costs associated with AF-related hospitalizations and emergency visits. RESULTS: The rate of AF-related hospitalizations was significantly lower in the DDDRP + MVP group than in the conventional pacemaker group (DDDR group; 42% reduction; incidence rate ratio 0.58). Similarly, a significant reduction of 68% was observed for AF-related emergency department visits (incidence rate ratio 0.32; P < .001). As a consequence, DDDRP + MVP could potentially reduce health care costs by 40%-44%. Over a ten-year period, the cost savings per 100 patients ranged from $35,702 in the United Kingdom to $121,831 in the United States. CONCLUSION: New pacing algorithms such as DDDRP + MVP used in the MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial successfully reduced AF-related health care utilization, resulting in significant cost savings to payers.
Authors: George H Crossley; Luigi Padeletti; Steven Zweibel; J Harrison Hudnall; Yan Zhang; Giuseppe Boriani Journal: Pacing Clin Electrophysiol Date: 2019-04-29 Impact factor: 1.976
Authors: Shaun Giancaterino; Marin Nishimura; Ulrika Birgersdotter-Green; Kurt S Hoffmayer; Frederick T Han; Farshad Raissi; Gordon Ho; David Krummen; Gregory K Feld; Jonathan C Hsu Journal: Pacing Clin Electrophysiol Date: 2020-05-02 Impact factor: 1.976