6 Implications for the NHS

6.1 About 25,000 pacemakers are implanted every year in the UK; three quarters of these are first implants, and one quarter are replacements.

6.2 The current hardware cost of pacemaker implantation based on the market cost of pacemakers and leads (see Section 3.2) and the proportion of pacemaker types implanted is about £43 million per year. This may underestimate the annual cost of pacemakers because the market price represents a substantial discount on the list price of pacemakers. However, the Institute does not have access to information on the list price of pacemakers.

6.3 Dual‑chamber pacemakers accounted for nearly 60% of the pacemakers implanted in 2003. The anticipated additional cost of implementing this guidance is dependent on the increased acquisition cost of dual‑chamber pacemakers, the number of patients with continuous atrial fibrillation who are not suitable for dual‑chamber pacing, and the likely uptake of dual‑chamber pacing. The uptake of dual‑chamber pacing is likely to vary between 70% and a theoretical maximum of 90%, for which the implementation cost varies between about £8 million and £10 million per year, based on the current implantation rate of pacemakers. This does not take into consideration potential differences in the staff and theatre costs between procedures for implanting dual‑ and single‑chamber pacemakers. The Institute was made aware that dual‑chamber pacing may be associated with slightly more follow‑up, which may have implications for the workload of staff in some trusts. However, the Institute does not have sufficient information to estimate the national impact of this guidance on human resources.