Belgian Health Care Knowledge Centre (KCE), Doorbuilding Kruidtuinlaan 55, B-1000, Brussels, Belgium.
BMC Cardiovasc Disord. 2013 Sep 26;13:78. doi: 10.1186/1471-2261-13-78.
A health technology assessment (HTA) of catheter ablation for atrial fibrillation (CA-AF) was commissioned by the Belgian government and performed by the Belgian Health Care Knowledge Centre (KCE). In this context, a systematic review of the economic literature was performed to assess the procedure's value for money.
A systematic search for economic literature about the cost-effectiveness of CA-AF was performed by consulting various databases: CRD (Centre for Reviews and Dissemination) HTA and CDSR (Cochrane Database of Systematic Reviews) Technology Assessment, websites of HTA institutes, NHS EED (NHS Economic Evaluation Database), Medline (OVID), EMBASE and EconLit. No time or language restrictions were imposed and pre-defined selection criteria were used. The two-step selection procedure was performed by two persons. References of the selected studies were checked for additional relevant citations.
Out of 697 references, seven relevant studies were selected. Based on current evidence and economic considerations, the rationale to support catheter ablation as first-line treatment was lacking.The economic evaluations for second-line catheter ablation included several assumptions that make the results rather optimistic or subject to large uncertainty. First, overall AAD (antiarrhythmic drugs) use after ablation was higher in reality than assumed in the economic evaluations, which had its impact on costs and effects. Second, several models focused on the impact of ablation on preventing stroke. This was questionable because there was no direct hard evidence from RCTs to support this assumption. An indirect impact through stroke on mortality should also be regarded with caution. Furthermore, all models included an impact on quality of life (QoL)/utility and assumed a long-term impact. Unfortunately, none of the RCTs measured QoL with a generic utility instrument and information on the long-term impact on both mortality and QoL was lacking.
Catheter ablation is associated with high initial costs and may lead to life-threatening complications. Its cost-effectiveness depends on the belief one places on the impact on utility and/or preventing stroke, and the duration of these effects. Having no hard evidence for these important variables is rather troublesome. Although the technique is widely spread, the scientific evidence is insufficient for drawing conclusions about the intervention's cost-effectiveness.
比利时政府委托比利时医疗保健知识中心（KCE）进行一项关于房颤导管消融术（CA-AF）的卫生技术评估（HTA）。在此背景下，对经济文献进行了系统回顾，以评估该程序的性价比。
通过查询各种数据库（Cochrane 系统评价数据库中的中心评价和检索数据库（CRD）、HTA 以及系统评价数据库（CDSR）、HTA 机构网站、NHS EED（NHS 经济评价数据库）、Medline（OVID）、EMBASE 和 EconLit），对关于 CA-AF 成本效益的经济文献进行了系统搜索。未对时间或语言进行限制，并使用了预先定义的选择标准。由两个人执行两步选择程序。检查了选定研究的参考文献，以获取其他相关引文。
在 697 篇参考文献中，选择了 7 篇相关研究。基于当前证据和经济考虑，缺乏支持导管消融作为一线治疗的基本原理。针对二线导管消融的经济评估包含了一些假设，这些假设使得结果较为乐观或存在较大的不确定性。首先，消融后抗心律失常药物（AAD）的总体使用量高于经济评估中的假设，这对成本和效果产生了影响。其次，一些模型侧重于消融对预防中风的影响。这是值得怀疑的，因为 RCT 没有直接的硬证据支持这一假设。通过中风对死亡率的间接影响也应谨慎对待。此外，所有模型都包含对生活质量（QoL）/效用的影响，并假设具有长期影响。不幸的是，没有 RCT 使用通用效用工具来衡量 QoL，并且缺乏关于死亡率和 QoL 的长期影响的信息。
导管消融术费用高昂，可能导致危及生命的并发症。其成本效益取决于对效用和/或预防中风的影响以及这些影响的持续时间的信念。这些重要变量缺乏确凿的证据，这令人感到困扰。尽管该技术得到广泛应用，但关于该干预措施成本效益的科学证据仍不足。
