Single-chamber pacemakers: with or without leads? Cost-effectiveness and cost-utility analyses.

Introduction: The evolution in pacemaker technologies has led to improvements in size, weight, functionality, and durability, even as the battery and electrode-based structural configuration has remained essentially the same.

Objective: To compare the cost-effectiveness and cost-utility of conventional and leadless pacemakers.

Material and methods: We conducted a retrospective observational study of 403 patients randomly implanted with a conventional or leadless pacemaker (1 June 2015-31 January 2020) in the Hospital-University Complex of Santiago de Compostela (Galicia, NW Spain).

Results: Conventional and leadless pacemakers were implanted in 244 and 159 patients, respectively. Leadless pacemakers were superior to the conventional pacemakers in terms of both cost-effectiveness and cost-utility, with incremental cost-effectiveness ratios of 6,263.38 euros per gained life year and of 5,210.71 euros per quality-adjusted life year, respectively.

Conclusions: Leadless pacemakers have fewer complications than conventional pacemakers and, although the device itself is more expensive, the leadless pacemaker is more cost-effective in around 90% of cases.