Health care cost analysis of enhanced pacing modalities in bradycardia patients: Portuguese case study on the results of the MINERVA trial

作     者：de Sous, Joao Marques, Pedro Martins, Vitor Hipolito-Reis, Antonio Duarte, Luis Joaquim, Ines Monteiro, Diogo Boriani, Giuseppe Wolff, Claudia Grammatico, Andrea Padeletti, Luigi 

作者机构：Ctr Hosp Lisboa Norte Lisbon Portugal Hosp Distrital Santarem Santarem Portugal Ctr Hosp Porto Porto Portugal Unidade Local Saude Baixo Alentejo Beja Portugal Medtronic Lisbon Portugal Univ Bologna S Orsola Malpighi Univ Hosp Bologna Italy Medtronic Tolochenaz Switzerland Medtronic Rome Italy Univ Florence Florence Italy 

出 版 物：《REVISTA PORTUGUESA DE CARDIOLOGIA》 (葡萄牙心血管病杂志)

年 卷 期：2018年第37卷第12期

页      面：973-978页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Medtronic St. Jude Medical Boston Scientific Corporation 

主　　题：Atrial fibrillation Bradycardia Pacemaker algorithms Health care cost 

摘      要：Introduction: The MINERVA trial established that atrial preventive pacing and atrial antitachycardia pacing (DDDRP) in combination with managed ventricular pacing (MVP) reduces progression to permanent atrial fibrillation (AF) in patients with paroxysmal or persistent AF and bradycardia who need cardiac pacing, compared to standard dual-chamber pacing (DDDR). It was shown that AF-related health care utilization was significantly lower in the DDDRP + MVP group than in the control group. Cost analysis demonstrated significant savings related to this new algorithm, based on health care costs from the USA, Italy, Spain and the UK. Objective: To calculate the savings associated with reduced health care utilization due to enhanced pacing modalities in the Portuguese setting. Methods: The impact on costs was estimated based on tariffs for AF-related hospitalizations and costs for emergency department and outpatient visits in Portugal. Results: The MINERVA trial showed a 42% reduction in AF-related health care utilization thanks to the new algorithm. In Portugal, this represents a potential cost saving of 2323 euros per 100 patients in the first year and 17 118 euros over a 10-year period. Considering the number of patients who could benefit from this new algorithm, Portugal could save a total of 75 369 euros per year and 555 410 euros over 10 years. Additional savings could accrue if heart failure and stroke hospitalizations were considered. Conclusion: The combination of atrial preventive pacing, atrial antitachycardia pacing and an algorithm to minimize the detrimental effect of right ventricular pacing reduces recurrent and permanent AF. The new DDDRP + MVP pacing mode could contribute to significant costs savings in the Portuguese health care setting. (C) 2018 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.