Abstract
Introduction
Radiofrequency catheter ablation (RFCA) is widely used to treat atrial fibrillation (AF) in China.
Objective
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.
Methods
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.
Results
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).
Conclusion
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.
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References
Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983–8.
Zhou Z, Hu D. An epidemiological study on the prevalence of atrial fibrillation in the Chinese population of Mainland China. J Epidemiol. 2008;18(5):209–16.
Boriani G, Diemberger I, Biffi M, Martignani C, Branzi A. Pharmacological cardioversion of atrial fibrillation: current management and treatment options. Drugs. 2004;64:2741–62.
Hamer ME, Blumenthal JA, McCarthy EA, et al. Quality-of-life assessment in patients with paroxysmal atrial fibrillation or paroxysmal superventricular tachycardia. Am J Cardiol. 1994;74(8):826–9.
Singh SN, Tang XC, Singh BN, et al. Quality of life and exercise performance in patients in sinus rhythm versus persistent atrial fibrillation. J Am Coll Cardiol. 2006;48(4):721–30.
Mont L, Bisbal F, Hernández-Madrid A, SARA Investigators, et al. Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study). Eur Heart J. 2014;35(8):501–7.
Stabile G, Bertaglia E, Senatore G, et al. Catheter ablation treatment in patients with drug-refractory atrial fibrillation: a prospective, multi-centre, randomized, controlled study (Catheter Ablation for the Cure of Atrial Fibrillation Study). Eur Heart J. 2006;27(2):216–21.
Wazni OM, Marrouche NF, Martin DO, et al. Radiofrequency ablation vs. antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation. JAMA. 2005;293:2634–40.
Jaïs P, Cauchemez B, Macle L, et al. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation the A4 study. Circulation. 2008;118:2498–505.
Weerasooriya R, Jaïs P, Le Heuzey JY, et al. Cost analysis of catheter ablation for paroxysmal atrial fibrillation. Pacing Clin Electrophysiol. 2003;26:292–4.
Khaykin Y, Wang X, Natale A, et al. Cost comparison of ablation versus antiarrhythmic drugs as first-line therapy for atrial fibrillation: an economic evaluation of the RAAFT pilot study. J Cardiovasc Electrophysiol. 2009;20:7–12.
Khaykin Y, Morillo CA, Skanes AC, McCracken A, Humphries K, Kerr CR. Cost comparison of catheter ablation and medical therapy in atrial fibrillation. J Cardiovasc Electrophysiol. 2007;18:907–13.
Rodgers M, McKenna C, Palmer S, et al. Curative catheter ablation in atrial fibrillation and typical atrial flutter: systematic review and economic evaluation. Health Technol Assess. 2008;12:1–198.
Aronsson M, Walfridsson H, Janzon M, et al. The cost effectiveness of radiofrequency catheter ablation as first-line treatment for paroxysmal atrial fibrillation: results from a MANTRA-PAF substudy. Europace. 2015;17(1):48–55.
Chan PS, Vijan S, Morady F, Oral H. Cost-effectiveness of radiofrequency catheter ablation for atrial fibrillation. J Am Coll Cardiol. 2006;47:2513–20.
Hu S, Zhan L, Liu B, et al. Economic burden of individual suffering from atrial fibrillation-related stroke in China. Value Health Reg Issues. 2013;2(1):135–40.
Neyt M, Van Brabandt H, Devos C. The cost–utility of catheter ablation of atrial fibrillation: a systematic review and critical appraisal of economic evaluations. BMC Cardiovasc Disord. 2013;26(13):78. https://doi.org/10.1186/1471-2261-13-78.
Guo Y, Tian Y, Wang H, et al. Prevalence, incidence, and lifetime risk of atrial fibrillation in China: new insights into the global burden of atrial fibrillation. Chest. 2015;147(1):109–19.
Xin D, Wu J, Guo X, et al. Clinical outcomes and health-related quality of life of catheter ablation vs. anti-arrhythmia drug therapy among atrial fibrillation patients in China. Circulation. 2015;132:A14799. http://circ.ahajournals.org/content/132/Suppl_3/A14799.short. Accessed 8 Sept 2016.
McKenna C, Palmer S, Rodgers M, et al. Cost-effectiveness of radiofrequency catheter ablation for the treatment of atrial fibrillation in the United Kingdom. Heart. 2009;95(7):542–9.
Assasi N, Blackhouse G, Xie F, et al. Ablation procedures for rhythm control in patients with atrial fibrillation: clinical and cost-effectiveness analyses [Technology Report, No. 128]. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2010.
Siu CW, Lip GY, Lam KF, Tse HF. Risk of stroke and intracranial hemorrhage in 9727 Chinese with atrial fibrillation in Hong Kong. Heart Rhythm. 2014;11(8):1401–8.
GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117–71.
Sun S, Chen J, Johannesson M, et al. Population health status in China: EQ-5D results, by age, sex and socio-economic status, from the National Health Services Survey 2008. Qual Life Res. 2011;20(3):309–20.
Marseille E, Larson B, Kazi DS, Kahn JG, Rosen S. Thresholds for the cost-effectiveness of interventions: alternative approaches. Bull World Health Organ. 2015;93:118–24.
Statistical Communiqué of the PR CHINA on the 2014 National Economic and Social Development. http://www.stats.gov.cn/english/PressRelease/201502/t20150228_687439.html. Accessed 6 Sept 2016.
Acknowledgements
This study was supported by an unrestricted grant from Johnson & Johnson Medical (China) Ltd.
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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.
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The datasets used for the cost-effectiveness analysis are not publicly available but may be available from the corresponding author on reasonable request.
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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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Du, X., He, X., Jia, Y. et al. A Long-Term Cost-Effectiveness Analysis Comparing Radiofrequency Catheter Ablation with Antiarrhythmic Drugs in Treatment of Chinese Patients with Atrial Fibrillation. Am J Cardiovasc Drugs 19, 569–577 (2019). https://doi.org/10.1007/s40256-019-00349-1
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DOI: https://doi.org/10.1007/s40256-019-00349-1