Khaykin Yaariv, Wang Xiaoyin, Natale Andrea, Wazni Oussama M, Skanes Allan C, Humphries Karin H, Kerr Charles R, Verma Atul, Morillo Carlos A
Division of Cardiology, Southlake Regional Health Center, Newmarket, Ontario, Canada.
J Cardiovasc Electrophysiol. 2009 Jan;20(1):7-12. doi: 10.1111/j.1540-8167.2008.01303.x. Epub 2008 Sep 17.
Radiofrequency ablation (RFA) has become an accepted therapy for atrial fibrillation (AF). The objective of this study was to perform an economic evaluation of RFA versus antiarrhythmic drug therapy (AAD) as first-line treatment of symptomatic paroxysmal AF.
To estimate and compare the costs of RFA versus AAD, a decision analytic model was developed using data on AF recurrence, hospitalization rates, AAD use, and treatment crossover rates derived directly from the Randomized Trial of RFA versus AAD as First-Line Treatment of Symptomatic Atrial Fibrillation (RAAFT). Resource utilization was modeled to reflect Canadian clinical practice in AF management. Unit costs of healthcare interactions were based on available Canadian government resources and published literature. Costs were assessed based on intention-to-treat. Total expected costs were computed to include initial treatment, hospital stay, physician fees, diagnostic tests, and outpatient visits. Sensitivity analyses were performed to account for the uncertainties. The study was conducted from the third party payer's perspective and costs are reported in 2005 Canadian dollars with 3% discount rate used in the analysis.
During the 2-month blanking period following therapy selection, total average costs for RFA and AAD were $10,465 and $2,556, respectively; at 1-year follow-up, these were $12,823 and $6,053; and total 2-year cumulative total average costs were $15,303 and $14,392. Sensitivity analyses did not alter the results, suggesting the model is robust.
RFA as first-line treatment strategy in patients with symptomatic paroxysmal AF was cost neutral 2 years after the initial procedure compared to AAD.
射频消融术（RFA）已成为心房颤动（AF）的一种公认治疗方法。本研究的目的是对RFA与抗心律失常药物治疗（AAD）作为有症状阵发性AF一线治疗方法进行经济学评估。
为了估计和比较RFA与AAD的成本，使用直接来自RFA与AAD作为有症状心房颤动一线治疗的随机试验（RAAFT）中关于AF复发、住院率、AAD使用和治疗交叉率的数据，开发了一个决策分析模型。对资源利用进行建模以反映加拿大房颤管理的临床实践。医疗保健互动的单位成本基于加拿大政府可用资源和已发表的文献。成本根据意向性治疗进行评估。计算总预期成本，包括初始治疗、住院时间、医生费用、诊断测试和门诊就诊。进行敏感性分析以考虑不确定性。该研究从第三方支付者的角度进行，成本以2005年加元报告，分析中使用3%的贴现率。
在治疗选择后的2个月空白期内，RFA和AAD的总平均成本分别为10465美元和2556美元；在1年随访时，分别为12823美元和6053美元；2年累计总平均成本分别为15303美元和14392美元。敏感性分析未改变结果，表明该模型具有稳健性。
与AAD相比，有症状阵发性AF患者将RFA作为一线治疗策略在初始手术后2年成本相当。
