Although they are more expensive, dual-chamber pacemakers are cost effective compared with single-chamber models because of reduced risk for hospitalization and disability, according to an article in the January 4th issue of Circulation.

“The dual-chamber devices significantly reduced the rates of atrial fibrillation and heart failure hospitalizations, which over the long term results in a highly favorable cost-effectiveness ratio,” said David J. Cohen, MD, MSc, a study coauthor.

The four-year, 2,010-patient Mode Selection in Sinus Node Dysfunction (MOST) study randomized 1,014 patients to dual-chamber devices and 996 to right-ventricular (single-chamber) pacing devices. The median age of patients was 74 years; 48 percent were women. All of the patients had sick sinus syndrome diagnosed by electrocardiogram.

Because the dual-chamber devices didn’t reduce mortality, the favorable cost-effectiveness observed in the study was “derived mainly from improved quality of life - fewer hospitalizations, less disability,” Cohen said.

Patients who received the dual-chamber devices were less likely to develop atrial fibrillation or to be hospitalized for heart failure than those who received single-chamber pacemakers. Patients receiving the dual-chamber devices also had a slightly lower risk of death or stroke, had better results on a heart failure score, and relatively small, but significantly better results on several measures of health-related quality of life.

After a detailed financial analysis, the authors concluded that compared with ventricular pacemakers, the dual-chamber devices have a projected gain of 0.17 quality-adjusted life years compared with single-chamber devices. “Although this increase in quality-adjusted years of life may seem modest, it compares favorably with other medical advances including r-tPA vs. streptokinase for suspected acute myocardial infarction (about 0.06 to 0.29 years of life), beta-blockers for low-risk survivors of heart attack (about 0.10 years of life), and stenting vs. balloon angioplasty for single-vessel coronary revascularization (about 0.03 quality-adjusted years of life),” the authors wrote.