Cost-effectiveness of a leadless vs transvenous dual chamber pacing strategy in the average UK pacing patient

Background

Dual-chamber pacing has traditionally relied on transvenous pacemaker implantation, a well established approach since its introduction in the 1960s. However, this method is associated with long-term complications, including lead-related issues and device infections(1,2), which can significantly impact patients’ quality of life and risk an exponential rise in morbidity with multiple lifetime procedures. Emerging leadless pacing technologies offer the potential to reduce these complications, albeit at a higher upfront cost.

Purpose

This project evaluated the potential benefits to patients and economic implications for the National Health Service (NHS) if de novo pacing patients received an AVEIR leadless dual-chamber system rather than a conventional transvenous device. The analysis modelled both clinical impact and cost-effectiveness considering outcomes from first implant at age 78 years(3) through one subsequent pacing procedure for generator replacement.

Methods

A longitudinal model was developed using published literature and local NHS Foundation Trust data to compare transvenous and leadless dual chamber pacing strategies. To assess the clinical and economic impact of different strategies, we considered the Department of Health’s newly published Value-Based Procurement framework. This methodology enabled a comprehensive evaluation of device acquisition costs, procedural expenses, complication rates, device longevity, NHS resource utilisation, and patient outcomes across both pacing strategies.

Results

Whilst leadless pacing systems currently incur a higher initial acquisition cost, the modelling suggests potential clinical benefits through a reduction in lead / wound related complications in the leadless cohort. A leadless strategy projects a £15,408 higher cost per patient over their lifetime compared with a tranvenous strategy (for the average UK pacemaker patient).

Despite this higher cost, a leadless strategy may offer improved clinical benefits including reduced risk of CIED infection (0.2% vs 2.2%). This may be of largest benefit to the most complex patients with highest PADIT/BLISTER score risk of infection.

Conclusion

Although dual-chamber leadless pacing currently represents a higher cost to the NHS, the clinical value to high risk or complex patients is considerable. By reducing infection related complications, procedural burden and physical discomfort leadless devices offer a tangible improvement in experience and long-term well-being. As procurement costs evolve, selective adoption of dual chamber leadless pacing in the more complex pacing patient may progress to represent less of an economic challenge, with significant benefit in patient focused care.