Chun K R Julian, Brugada Josep, Elvan Arif, Gellér Laszlo, Busch Matthias, Barrera Alberto, Schilling Richard J, Reynolds Matthew R, Hokanson Robert B, Holbrook Reece, Brown Benedict, Schlüter Michael, Kuck Karl-Heinz
Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.
Hospital Clinic, Barcelona, Spain.
J Am Heart Assoc. 2017 Jul 27;6(8):e006043. doi: 10.1161/JAHA.117.006043.
This study sought to assess payer costs following cryoballoon or radiofrequency current (RFC) catheter ablation of paroxysmal atrial fibrillation in the randomized FIRE AND ICE trial.
A trial period analysis of healthcare costs evaluated the impact of ablation modality (cryoballoon versus RFC) on differences in resource use and associated payer costs. Analyses were based on repeat interventions, rehospitalizations, and cardioversions during the trial, with unit costs based on 3 national healthcare systems (Germany [€], the United Kingdom [£], and the United States [$]). Total payer costs were calculated by applying standard unit costs to hospital stays, using diagnoses and procedure codes that were mapped to country-specific diagnosis-related groups. Patients (N=750) randomized 1:1 to cryoballoon (n=374) or RFC (n=376) ablation were followed for a mean of 1.5 years. Resource use was lower in the cryoballoon than the RFC group (205 hospitalizations and/or interventions in 122 patients versus 268 events in 154 patients). The cost differences per patient in mean total payer costs during follow-up were €640, £364, and $925 in favor of cryoballoon ablation (=0.012, 0.013, and 0.016, respectively). This resulted in trial period total cost savings of €245 000, £140 000, and $355 000.
When compared with RFC ablation, cryoballoon ablation was associated with a reduction in resource use and payer costs. In all 3 national healthcare systems analyzed, this reduction resulted in substantial trial period cost savings, primarily attributable to fewer repeat ablations and a reduction in cardiovascular rehospitalizations with cryoballoon ablation.
URL: http://www.clinicaltrials.gov. Identifier: NCT01490814.
本研究旨在评估随机对照的“冷冻与射频电流（FIRE AND ICE）”试验中，冷冻球囊或射频电流（RFC）导管消融阵发性心房颤动后的支付方成本。
一项关于医疗成本的试验期分析评估了消融方式（冷冻球囊与RFC）对资源使用差异及相关支付方成本的影响。分析基于试验期间的重复干预、再次住院和心律转复情况，单位成本基于3个国家医疗系统（德国[€]、英国[£]和美国[$]）。通过将标准单位成本应用于住院情况，使用映射到特定国家诊断相关组的诊断和程序代码来计算支付方总成本。750例患者按1:1随机分为冷冻球囊消融组（n = 374）或RFC消融组（n = 376），平均随访1.5年。冷冻球囊组的资源使用低于RFC组（122例患者中有205次住院和/或干预，而154例患者中有268次事件）。随访期间，每位患者平均支付方总成本的成本差异分别为冷冻球囊消融组比RFC组节省640欧元、364英镑和925美元（P值分别为0.012、0.013和0.016）。这导致试验期总成本节省分别为245,000欧元、140,000英镑和355,000美元。
与RFC消融相比，冷冻球囊消融与资源使用和支付方成本的降低相关。在所有3个分析的国家医疗系统中，这种降低导致试验期成本大幅节省，主要归因于冷冻球囊消融的重复消融次数减少和心血管疾病再次住院率降低。
