Eckard Nathalie, Davidson Thomas, Walfridsson Håkan, Levin Lars-Åke
Center for Medical Technology Assessment (CMT), Department of Medical and Health Sciences, Linköping University, Sweden.
Department of Cardiology, Linköping University Hospital, Sweden.
J Atr Fibrillation. 2009 Aug 1;2(2):195. doi: 10.4022/jafib.195. eCollection 2009 Aug-Sep.
Atrial Fibrillation is the most common cardiac arrhythmia. It increases the risk of thromboembolic events and many atrial fibrillation patients suffer quality of life impairment due to disturbed heart rhythm. Pulmonary vein isolation using radiofrequency catheter ablation treatment is aimed at maintaining sinus rhythm ultimately improving quality of life. Randomized clinical trial have shown that catheter ablation is more effective than antiarrhythmic drugs for the treatment of atrial fibrillation, but its impact on quality of life and cost-effectiveness has not been widely studied. To assess the cost-effectiveness of radiofrequency ablation (RFA) vs. antiarrhythmic drug (AAD) treatment, among symptomatic atrial fibrillation patients not previously responding to AAD. A decision-analytic Markov model was developed to assess costs and health outcomes in terms of quality adjusted life years (QALYs) of RFA and AAD over a lifetime time horizon. We conducted a literature search and used data from several sources as input variables of the model. One-year rates of atrial fibrillation with RFA and AAD, respe tively, were available from published randomized clinical trials. Other data sources were published papers and register data. The RFA treatment strategy was associated with reduced costs and an incremental gain in QALYs compared to the AAD treatment strategy. The results were sensitive to whether long-term quality of life improvement is maintained for the RFA treatment strategy and the risk of stroke in the different atrial fibrillation health states. This study shows that the short-term improvement in atrial fibrillation associated with RFA is likely to lead to long-term quality of life improvement and lower costs indicating that RFA is cost-effective compared to AAD.
心房颤动是最常见的心律失常。它会增加血栓栓塞事件的风险，许多心房颤动患者因心律紊乱而生活质量受损。使用射频导管消融治疗进行肺静脉隔离旨在维持窦性心律，最终改善生活质量。随机临床试验表明，导管消融治疗心房颤动比抗心律失常药物更有效，但其对生活质量和成本效益的影响尚未得到广泛研究。为了评估射频消融（RFA）与抗心律失常药物（AAD）治疗对先前对AAD无反应的有症状心房颤动患者的成本效益。我们开发了一个决策分析马尔可夫模型，以评估在终身时间范围内RFA和AAD的成本和以质量调整生命年（QALY）衡量的健康结果。我们进行了文献检索，并使用来自多个来源的数据作为模型的输入变量。已发表的随机临床试验提供了RFA和AAD分别导致的心房颤动一年发生率。其他数据来源是已发表的论文和登记数据。与AAD治疗策略相比，RFA治疗策略与成本降低和QALY的增量收益相关。结果对RFA治疗策略是否能维持长期生活质量改善以及不同心房颤动健康状态下的中风风险敏感。这项研究表明，与RFA相关的心房颤动短期改善可能会导致长期生活质量改善和成本降低，这表明与AAD相比，RFA具有成本效益。
