Economic and health consequences of managing bradycardia with dual-chamber compared to single-chamber ventricular pacemakers in Italy
Why this work is in the frame
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Bibliographic record
Abstract
OBJECTIVE: This study sought to estimate the economic implications of managing bradycardia due to sinoatrial node disease or atrioventricular block with dual compared to single-chamber ventricular pacemakers from an Italian government perspective. Dual-chamber pacemakers lower the risk of developing atrial fibrillation and pacemaker syndrome. METHODS: A discrete event simulation of a patient's course for 5 years following pacemaker implantation. Each patient may experience the following: complications, pacemaker syndrome, atrial fibrillation, stroke, or death. Risk functions were based on published data from the Canadian Trial of Physiologic Pacing and Mode Selection Trial in Sinus-Node Dysfunction. Identical patients were simulated after receiving a single or dual-chamber pacemaker. Quality-adjusted life-years (QALYs) and direct medical costs were estimated (2004 Euros). Benefits and costs were discounted at 3%. RESULTS: The model predicts that implanting the dual-chamber device in 1000 patients will prevent 36 patients from developing atrial fibrillation, 168 from developing severe pacemaker syndrome, but will lead to 13 additional hospitalizations with complications over 5 years. Health benefits are achieved at an incremental cost of 23 euros per patient, and 0.09 QALY, yielding an incremental cost-effectiveness ratio of euro 260 euros/QALY. Sensitivity analysis shows that device replacement rates due to pacemaker syndrome have the biggest impact on the final results. CONCLUSIONS: In the long term, higher initial costs of the dual-chamber device may be offset by a reduction in costs associated with reoperations and atrial fibrillation.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it