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Health values before and after pacemaker implantation

  • Author(s): Lopez-Jimenez, F
  • Goldman, L
  • Orav, EJ
  • Ellenbogen, K
  • Stambler, B
  • Marinchak, R
  • Wilkoff, BL
  • Mangione, CM
  • Yoon, C
  • Vitale, K
  • Lamas, GA
  • et al.
Abstract

Background: Health value or utility is the abstracted magnitude of a person's preference for quality and quantity of life. It reflects how much lifetime with the patient's current health condition a patient is willing to exchange for a life in excellent health. Health values are used in cost-effectiveness analysis as a means of calculating quality-adjusted years of life. Objective: This study assessed the health values of elderly patients before and after pacemaker implantation. Methods: We prospectively examined 398 patients from the Pacemaker Selection in the Elderly study, in which patients were randomized to either VVIR or DDDR mode. Health values were estimated with the time tradeoff method before implantation and at 3, 9, and 18 months after implantation. Results: The mean age of patients was 76 ± 6 years; 234 patients (59%) were male. At baseline, patients were, on average, willing to exchange 5 years of current health for approximately 4 years in perfect health (value 0.76 ± 0.06). There was no difference in baseline health values with implant diagnosis (sinus node dysfunction n = 172, 0.72, atrio-ventricular block n = 227, 0.75, other diagnoses n = 39, 0.78, P = not significant). The overall improvement in health values at 3 months after pacemaker implantation was O.165 ± 0.4 (P = .0001). The improvement in health values was independent of pacing mode (P = .6). The time tradeoff score was modestly correlated with other measurements of health-related quality of life. The change in time tradeoff score with time was not influenced by demographic characteristics such as age and sex, diagnoses, pacing mode, employment status, or history of angina. Patients with a lower functional class at enrollment (III or IV on the Specific Activity Scale) demonstrated an absolute improvement of 23% in their health values, whereas patients in class I or II improved only by 12%, (P = .03). Conclusions: Permanent pacemaker implantation for standard indications improves health values and descriptive health status measures. The values reported here may be used as a means of calculating the cost-effectiveness of different pacing modalities.

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