Choosing an electronic cardiac pacemaker: A decision analysis

Abstract Cardiac pacemaker malfunctions are of continuous concern to the medical profession as well as to the electronics industry. Several dozen pacemaker models are on the market and cardiologists often find it difficult to choose amongst them. The main concern is for the distribution of the various failure modes due to premature battery exhaustion or malfunctions in the electronic circuit, and the criticality of the failure. This paper employs a decision analytic framework to help cardiologists choose among several pacemaker models. Failure data were obtained from the literature and a utility function over failure outcomes was elicited from a cardiologist. The paper presents a ‘Batch Reliability Comparison’ method for utility assessment which might also be attractive in other reliability settings. Three specific pacemaker models used at the Chaim Sheba Medical Center were evaluated. The expected utility approach yielded a different ranking than the conventional expected life approach. The results have already been implemented even though they implied choosing a different model than was originally preferred.