Atrial Automatic Tachycardia-Reversion Pacemakers: Their Economic Viability and Impact on Quality-of-Life

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Abstract
Refractory supraventricular tachyarrhythmias may be both difficult and costly to control medically and can interfere with the patient's lifestyle. Newer treatment modalities are available for their management, and these require comprehensive assessment. We therefore compared costs and selective indices of patient benefit in a group of 17 patients in whom an atrial antitachycardia (Intermedics Intertach 262-12) pacemaker was placed for refractory supraventricular tachyarrhythmias. Prior medical therapy was compared to subsequent automatic antitachycardia pacemaker treatment. The total medical costs (admissions, emergency room visits, office visits, and medication costs) and the number of hospitalizations and medications were compared prior to implantation (F/U 69.3 +/- 61 months) and after implantation (F/U 15.3 +/- 7.8 months). A detailed quality-of-life questionnaire was also obtained 36.6 +/- 11 months after implantation. There were significant per patient differences in total cost before and after implantation: monthly costs were $505 +/- $833 before pacemaker implantation and $105 +/- $117 monthly afterward (P less than 0.005). Pacemaker implantation hospitalization costs were $19,063 +/- $8,362. Monthly medication costs averaged $46 before versus $15 after implantation (P less than 0.01). The number of medication types also differed with an average 5.5 medication types per patient before versus 1.2 after implantation (P less than 0.001). There were 8.6 yearly hospital admissions in the whole group before implantation, versus 4.7 admissions in the group per year thereafter. Patients demonstrated significant improvement in 80% of the quality-of-life parameters studied. Adjunctive atrial automatic tachycardia-reversion pacemaker therapy may be cost-competitive over time when compared to medical therapy alone in patients with refractory supraventricular tachyarrhythmias and appears to improve overall quality-of-life.