a Center for Health Policy and Media Engagement , George Washington University School of Nursing, and Department of Health Policy and Management, George Washington University Milken Institute School of Public Health , Washington , DC , USA.
b Partnership for Health Analytic Research LLC , Beverly Hills , CA , USA.
Curr Med Res Opin. 2019 Jun;35(6):957-961. doi: 10.1080/03007995.2018.1546681. Epub 2018 Dec 6.
Data related to the cost effectiveness of surgical interventions and catheter ablation is sparse. This model-based analysis assessed the clinical and economic trade-offs involved in using catheter ablation or the Cox maze procedure in treating patients with atrial fibrillation.
A deterministic model was developed to project 1 year and lifetime health-related outcomes, costs, quality-adjusted life years (QALYs) and cost effectiveness of each treatment in patients with atrial fibrillation. Using previously unpublished Inova Heart and Vascular Institute (IHVI) data for patients undergoing either procedure, 1 year cost and clinical efficacy inputs were estimated. This data was supplemented with published literature and used to estimate costs, utilities, mortality and likelihood of patient improvement. Results were reported as cost-effectiveness ratios in $/QALY. Sensitivity analyses were conducted to assess the robustness of results.
Patients initially treated with a Cox maze procedure were estimated to have higher costs than those treated with catheter ablation, both after 1 year and over the lifetime. However, patients undergoing the Cox maze procedure also had lower rates of 1 year mortality than catheter ablation patients (3.5% vs. 8.5%) and the highest rate of improvement following treatment, resulting in higher QALYs (12.4 vs. 10.2). Compared to catheter ablation, the lifetime incremental cost-effectiveness ratio for the Cox maze surgical procedure was $12,794 per QALY gained. Without quality adjustment, the ratio was $11,315. Results were most sensitive to the likelihood of improvement following each intervention and the cost of the initial procedure.
At a societal willingness to pay of $100,000/QALY, Cox maze procedure was found to both increase overall and quality-adjusted survival and constitute an effective use of resources in patients with atrial fibrillation.
与手术干预和导管消融的成本效益相关的数据较为匮乏。本基于模型的分析评估了在治疗房颤患者时使用导管消融或柯克斯迷宫手术的临床和经济权衡。
开发了一个确定性模型，以预测 1 年和终身与健康相关的结果、成本、质量调整生命年 (QALY) 以及每种治疗方法的成本效益。使用先前未公布的因诺瓦心脏和血管研究所 (IHVI) 接受两种手术的患者数据，估计了 1 年的成本和临床疗效输入。该数据补充了已发表的文献，并用于估计成本、效用、死亡率和患者改善的可能性。结果以每 QALY 的成本效益比报告。进行了敏感性分析以评估结果的稳健性。
最初接受柯克斯迷宫手术治疗的患者估计比接受导管消融治疗的患者在 1 年和终身都有更高的成本。然而，接受柯克斯迷宫手术的患者 1 年死亡率也低于导管消融患者 (3.5%比 8.5%)，并且治疗后改善率最高，导致 QALY 更高 (12.4 比 10.2)。与导管消融相比，柯克斯迷宫手术的终生增量成本效益比为每获得 1 个 QALY 增加 12794 美元。未经质量调整，该比率为 11315 美元。结果对每种干预措施后的改善可能性和初始程序的成本最为敏感。
在社会愿意为每个 QALY 支付 100,000 美元的情况下，柯克斯迷宫手术被发现既增加了总体和质量调整后的生存率，又有效地利用了资源，可用于房颤患者。
