A Long-Term Cost-Effectiveness Analysis Comparing Radiofrequency Catheter Ablation with Antiarrhythmic Drugs in Treatment of Chinese Patients with Atrial Fibrillation
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Radiofrequency catheter ablation (RFCA) is widely used to treat atrial fibrillation (AF) in China.
We aimed to determine the long-term cost effectiveness of RFCA versus antiarrhythmic drugs (AADs) in treating AF from the perspective of third-party payers.
The model was structured as a 12-month decision tree leading to a Markov model that simulated the follow-up treatment outcomes and costs with time horizons of 8, 15, and 20 years. Comparators were standard-of-care AADs. Clinical parameters captured normal sinus rhythm, AF, stroke, post-stroke, intracranial hemorrhage (ICH), gastrointestinal bleeding, post-ICH, and death. The risk of operative death, procedural complications, and adverse drug toxicity were also considered. The model output was quality-adjusted life-years (QALYs) and incremental cost per QALY gained.
RFCA incurred more costs than the AADs but resulted in more QALYs gained than did AADs. The incremental cost per QALY gained with RFCA versus AADs was ¥66,764, ¥36,280, and ¥29,359 at 8, 15, and 20 years, respectively. The sensitivity analyses showed that the results were most sensitive to the changes in RFCA cost and CHADS2 score (clinical prediction rule for assessing the risk of stroke in patients with non-rheumatic AF).
Compared with AADs, RFCA significantly improves clinical outcomes and QALYs among patients with paroxysmal or persistent AF. From the Chinese payer’s perspective, RFCA is a cost-effective therapy over long-term horizons.
This study was supported by an unrestricted grant from Johnson & Johnson Medical (China) Ltd.
XD, XH, YJ, JX, and CM designed and led the study. XD, XH, JW, DL, RY, CS, JD, and CM contributed to the clinical investigation and data collection. XD, YJ, JH, HY, JX, and CM participated in the model development, data analysis, and interpretation of results. XD, XH, YJ, JW, DL, RY, CS, HY, JX, JD, and CM contributed to the study management, discussions, and study report and manuscript preparation. All authors read and approved the final manuscript.
Compliance with Ethical Standards
This article does not contain any studies performed with human or animal participants.
Availability of data and materials
The datasets used for the cost-effectiveness analysis are not publicly available but may be available from the corresponding author on reasonable request.
Conflict of interest
XD, HY, JX, and CM received research funding from Johnson & Johnson Medical (China) Ltd. YJ is an employee at Johnson & Johnson Medical (China) Ltd. XH, JW, DL, RY, CS, and JD have no conflicts of interest that are directly relevant to the content of this article.
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