The Evaluation Of Cardiac Pacemaker By Medical Economics

Objective To study the cost of Cardiac Pacemaker now in our country.To evaluate the therapy of cardiac pacing by medical economics,use the limited health resources reasonablly and elevate patient's long term survival quality.Method To collect 405 postoperation patient's data in which the pacers were implanted by cardiac medical department,all these patients were correspond to the selected standard.To record the patients' basic condition,the type of pacer,the cost of treatment and operation,the pay way of cost,the condition of the basic disease, the cardiac functional grading,the score of quality of life et al.To follow up the change of the score of quality of life 6 months later,the continued cost,the complication of short-term and long-term.Results The patients who accepted the operation of implanting pacer have gotten the obvious improvement in the quality of life.404 patients' quality of life have been improved obviously besides 1 patient died from non-cardiac reason(stroke),but the change is different in different type of pacer and AAI,DDD are better than VVI. Nobody died from sudden death in 28 patients who accepted ICD or CRT-D.The patients' quality of life,symptom and physical sign postoperation 1 moth later demonstrate the patients' heart function has improved obviously.All cost of the patients who accepted implanting of pacer:VVI is￥(3.12±1.50)×10~4,DDD is￥(4.88±1.92)×10~4,ICD is￥(8.05±3.95)×10~4,CRT is￥(10.22±1.09)×10~4,CRT-D is￥(20.31±10.54)×10~4.The average percent of pacer in all direct cost:VVI is (79.25±2.55)%,DDDis(82.17±7.02)%,CRT is(86.80±6.94)%,ICD is (79.32±6.55)%,CRT-D is(83.24±8.11)%.The average cost of replacement: AAI is￥(2.89±0.04)×10~4,VVI is￥(2.63±0.58)×10~4,DDD is￥(3.82±1.79)×10~4,CRT is￥(10.46±0.85)×10~4,CRT-D is￥(20.59±1.11)×10~4,ICD is￥(6.85±2.15)×10~4.All 405 pacemakers are imported from foreign countries.In 405 pacemakers,there are 175 VVI-pacemkers,2 AAI-pacemakers,183 DDD-pacemakers,17 CRT-pacemakers,6 CRT-Ds,22 ICDs.After final diagnosis, there are 323 patients who accepted implanting for the first time,82 patients who have been replaced for one or more times.219 patients enjoy the society basic medical insurance,20 patients enjoy state medicine and 166 patients are at their own expense.There are 185 physiological pacmaker,including AAI,VVIR,DDD, DDDR,in 405 patients.169 patients are implanted pacmaker because of SSS,171 are implanted because of AVB,19 are implanted because of binodal disease,1 is implanted because of nervous apopsychia,23 are implanted CRT or CRT-D because of DCM,22 are implanted ICD because of VT/VF.In 323 patients who accepted implanting for the first time,there are 270 patients who are over 60 years old and they are the main body who accepted implanting.For the implanting of the first time, the man's mean age is(68.08±12.78),the woman's mean age is(65.50±14.21). There are 4 patients who have happened loose electrode placement,2 patients who have happened pocket infection within 1 moth,1 VVI-patient happened PMS.The mean use age in 82 patients who experienced recovered pacemaker:AAI is (9.80±0.14),VVI is(9.07±0.70),DDD is(7.72±0.81),ICD is(5.70±0.55),CRT is (5.42±0.13),CRT-D is(5.11±0.08).Conclusion①There are powerful odds that the cardiac pacing elevate survival rate,improve quality of life,diminish hospitalization rate,boost physical working capacity to treat the bradyarrhythmia and tachyarrhythmia.Cardiac pacing also have the forte of rapid excellence,easy replacement.Cardiac pacing should be generalized and pervasion..②More and more people will benefit in cardiac pacing by the consummate system of medical care assurance and extending people of medical care assurance.③It is useful for generalizing the cardiac pacing to cut down the cost price of cardiac pacing by manufacturing and developping pacemaker which has the Chinese intellectual property rights and enhancing economic strength of our country.④It is helpful for improving the appearance of medical economics in cardiac pacing to grasp clinical indication of cardiac pacing strictly,lower incidence of complication and prolong serviceable life of pacer by optimizing the pacing system dynamicly.