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. 2023 Mar 30;25(3):1087-1099.
doi: 10.1093/europace/euad003.

Cost-effectiveness analysis of cardiac implantable electronic devices with reactive atrial-based antitachycardia pacing

Takashi Noda  1   2 , Nobuhiko Ueda  1 , Yuji Tanaka  3 , Yoko Ishiguro  3 , Tomoko Matsumoto  3 , Tatsuhiro Uenishi  4 , Hiroko Yamaguchi  4 , Ayako Shoji  4   5 , Jae-Eun Myung  6   7 , Kengo Kusano  1
Affiliations

Cost-effectiveness analysis of cardiac implantable electronic devices with reactive atrial-based antitachycardia pacing

Takashi Noda et al. Europace. .

Abstract

Aims: Reactive atrial-based anti-tachycardia pacing (rATP) in pacemakers (PMs) and cardiac resynchronization therapy defibrillators (CRT-Ds) has been reported to prevent progression of atrial fibrillation, and this reduced progression is expected to decrease the risk of complications such as stroke and heart failure (HF). This study aimed to assess the cost-effectiveness of rATP in PMs and CRT-Ds in the Japanese public health insurance system.

Methods and results: We developed a Markov model comprising five states: bradycardia, post-stroke, mild HF, severe HF, and death. For devices with rATP and control devices without rATP, we compared the incremental cost-effectiveness ratio (ICER) from the payer's perspective. Costs were estimated from healthcare resource utilisation data in a Japanese claims database. We evaluated model uncertainty by analysing two scenarios for each device. The ICER was 763 729 JPY/QALY (5616 EUR/QALY) for PMs and 1,393 280 JPY/QALY (10 245 EUR/QALY) for CRT-Ds. In all scenarios, ICERs were below 5 million JPY/QALY (36 765 EUR/QALY), supporting robustness of the results.

Conclusion: According to a willingness to pay threshold of 5 million JPY/QALY, the devices with rATP were cost-effective compared with control devices without rATP, showing that the higher reimbursement price of the functional categories with rATP is justified from a healthcare economic perspective.

Keywords: Atrial anti-tachycardia pacing; Atrial fibrillation; Cardiac resynchronization therapy; Cost-effectiveness; Heart failure; Pacemaker.

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Conflict of interest statement

Conflict of interest: Y.T., Y.I., and T.M. are employees of Medtronic Japan, and J.-E.M. is an employee of Medtronic Korea. T.U., H.Y., and A.S. are employees of Medilead, which was commissioned by Medtronic Japan. K.K., T.N., and N.U. have received compensation for advisory services for this study from Medtronic Japan and other payments, including honoraria, for lectures which were not directly associated with this study from Medtronic Japan. K.K. has received speaker honoraria from Medtronic Japan, Biotronik Japan and Boston Scientific and research grants from Medtronic Japan and Biotronik Japan. The authors have no other conflicts of interest to disclose.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Markov model diagram. For the pacemaker analysis, all patients were entered into the model in the bradycardia without atrial fibrillation, and no replacement with cardiac resynchronization therapy was performed in case of transition to heart failure; for cardiac resynchronisation therapy device, all patients were entered into the model in the mild HF state. AF, atrial fibrillation; HF, heart failure.
Figure 2
Figure 2
Tornado diagram. (A) Pacemaker. AF, atrial fibrillation; HF, heart failure; ICER, incremental cost-effectiveness ratio; JPY, Japanese yen; QALY, quality-adjusted life year; rATP, reactive atrial-based anti-tachycardia pacing. (B) Cardiac resynchronisation therapy device. AF, atrial fibrillation; HF, heart failure; ICER, incremental cost-effectiveness ratio; JPY, Japanese yen; QALY, quality-adjusted life year; rATP, reactive atrial-based anti-tachycardia pacing.
Figure 3
Figure 3
Cost-effectiveness acceptability curve. (A) Pacemaker. JPY, Japanese yen. (B) Cardiac resynchronization therapy device. JPY, Japanese yen.
Figure 4
Figure 4
Incremental cost-effectiveness ratio scatter. (A) Pacemaker. ICER, incremental cost-effectiveness ratio; JPY, Japanese yen; QALYs, quality-adjusted life years; WTP, willingness to pay. (B) Cardiac resynchronisation therapy device. ICER, incremental cost-effectiveness ratio; JPY, Japanese yen; QALYs, quality-adjusted life years; WTP, willingness to pay.
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