Identifying Incremental Costs For Successive Generations Of Implantable Cardiac Pacemakers

This paper provides an assessment of the incremental expected costs of increasingly sophisticated generations of cardiac pacemaker technology. A decision analytic framework is used to calculate expected costs of pacemaker therapy over a five-year period, taking into account failure rate estimates for the various generations, device replacement costs, hospital fees, physician's fees, follow-up care, and patient lost time in follow-up care. For five years of pacing therapy, the incremental cost difference between nonpro grammable and multiprogrammable is $1887; between multiprogrammable and dual-chamber is $3321; and between dual-chamber and dual-chamber rate-responsive is $676. Incremental benefits were found extremely difficult to quantify, monetarize, or translate to a scale for comparison with costs. However, medical literature indicates a decreasing level of risk for mortality and morbidity, owing to increased hemodynamic benefits from the more recent generations of high technology pacemakers.