Xue-Rong Sun1, Shu-Nan He2, Zi-Yi Lin3, Lei Zhang3, Yan-Jiang Wang1, Li-Jun Zeng1, Liang Shi1, Jian-Wei Xuan4, Ying Tian1, Xin-Chun Yang1, Xing-Peng Liu5. 1. Center for Atrial Fibrillation, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China. 2. Department of Cardiology, Beijing Lu-He Hospital, Capital Medical University, Beijing, China. 3. Shanghai Centennial Scientific Co, Ltd, Shanghai, China. 4. Health Economic Research Institute, Sun Yat-Sen University, Guangzhou, China. 5. Center for Atrial Fibrillation, Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China. Electronic address: xpliu71@vip.sina.com.
Abstract
PURPOSE: The aim of this study was to evaluate the cost-effectiveness of radiofrequency catheter ablation (RFCA) compared with cryoballoon (CB) ablation in the treatment of patients with paroxysmal atrial fibrillation (PAF) from the payer's perspective in China. METHODS: We constructed a cohort model, combining a 12-month decision-tree model with a lifetime Markov state-transition model, in a hypothetical cohort of patients with drug-refractory PAF managed with either RFCA or CB ablation, to compare the cost-effectiveness of the 2 procedures. Data related to clinical outcomes and costs in this model were obtained from a retrospective 12-month follow-up study in patients in China and from related literature. The incremental cost-effectiveness ratio (ICER) over a 10-year time period was calculated and compared against the willingness-to-pay (WTP) threshold. We used a 1-way sensitivity analysis and a probabilistic sensitivity analysis (PSA) to access the structural uncertainty and the parameter uncertainty, respectively. FINDINGS: Over a 10-year time horizon, the total costs per patient of RFCA and CB ablation were ¥98,164.04 (US $15,339.57; €13,058.94) and ¥107,542.37 ($16,805.07; €14,306.55), respectively, and quality-adjusted life-years (QALYs) gained were 5.47 and 5.43, respectively. The ICER ratio was -¥224,365.01 (-$35,060.32; -€29,847.68) per QALY, indicating that RFCA is associated with greater QALYs and lower costs than CB ablation. The 1-way sensitivity analysis demonstrated that the model results were most sensitive to the odds ratio of the atrial fibrillation recurrence within 12 months in the RFCA group versus the CB ablation group, the cost of RFCA, and the perioperative stroke risk with RFCA. According to the results of the PSA, RFCA was associated with a high probability of being cost-effective (99.48%) compared with CB ablation at a WTP threshold of ¥161,940 ($25,305.50; €21,543.17) per QALY. IMPLICATIONS: Our analysis indicates that RFCA is cost-saving compared with CB ablation in the treatment of patients with PAF in China, based on better QALYs and lower costs over a 10-year time horizon, from the payer's perspective.
PURPOSE: The aim of this study was to evaluate the cost-effectiveness of radiofrequency catheter ablation (RFCA) compared with cryoballoon (CB) ablation in the treatment of patients with paroxysmal atrial fibrillation (PAF) from the payer's perspective in China. METHODS: We constructed a cohort model, combining a 12-month decision-tree model with a lifetime Markov state-transition model, in a hypothetical cohort of patients with drug-refractory PAF managed with either RFCA or CB ablation, to compare the cost-effectiveness of the 2 procedures. Data related to clinical outcomes and costs in this model were obtained from a retrospective 12-month follow-up study in patients in China and from related literature. The incremental cost-effectiveness ratio (ICER) over a 10-year time period was calculated and compared against the willingness-to-pay (WTP) threshold. We used a 1-way sensitivity analysis and a probabilistic sensitivity analysis (PSA) to access the structural uncertainty and the parameter uncertainty, respectively. FINDINGS: Over a 10-year time horizon, the total costs per patient of RFCA and CB ablation were ¥98,164.04 (US $15,339.57; €13,058.94) and ¥107,542.37 ($16,805.07; €14,306.55), respectively, and quality-adjusted life-years (QALYs) gained were 5.47 and 5.43, respectively. The ICER ratio was -¥224,365.01 (-$35,060.32; -€29,847.68) per QALY, indicating that RFCA is associated with greater QALYs and lower costs than CB ablation. The 1-way sensitivity analysis demonstrated that the model results were most sensitive to the odds ratio of the atrial fibrillation recurrence within 12 months in the RFCA group versus the CB ablation group, the cost of RFCA, and the perioperative stroke risk with RFCA. According to the results of the PSA, RFCA was associated with a high probability of being cost-effective (99.48%) compared with CB ablation at a WTP threshold of ¥161,940 ($25,305.50; €21,543.17) per QALY. IMPLICATIONS: Our analysis indicates that RFCA is cost-saving compared with CB ablation in the treatment of patients with PAF in China, based on better QALYs and lower costs over a 10-year time horizon, from the payer's perspective.