Department of Cardiology, S. Chiara Hospital, Trento, Italy.
Department of Physics, S. Chiara Hospital, Trento, Italy.
Biomed Res Int. 2019 Aug 20;2019:2427015. doi: 10.1155/2019/2427015. eCollection 2019.
In this study we estimated the cost-effectiveness of adopting 3D Nonfluoroscopic Mapping Systems (NMSs) for catheter ablation (CA).
This study includes patients who underwent supraventricular tachycardia (SVT) CA and atrial fibrillation (AF) CA from 2007 to 2016. A comparison was conducted between a reference year (2007) and the respective years for the two types of procedure in which the maximum optimization of patients' exposure using NMSs was obtained. We compared the data of all SVT CA performed solely using fluoroscopy in 2007 (Group I) and all SVT CA procedures performed using fluoroscopy together with an NMS in 2011 (Group II). There was also an important comparison made between AF CA procedures performed in 2007 (Group III) and AF CA in 2012 (Group IV), where patients' treatment in both years included the use of an NMS but where the software and hardware versions of the NMS were different. Two cost-effectiveness analyses were carried out. The first method was based on the alpha value (AV): the AV is a monetary reference value of avoided unit of exposure and is expressed as $/mansievert. The second one was based on the value of a statistical life (VSL): the VSL does not represent the cost value of a person's life, but the amount that a community would be willing to pay to reduce the risk of a person's death. The costs estimated from these two methods were compared to the real additional cost of using an NMS during that type of procedure in our EP Lab.
The use of NMS reduced the effective dose of about 2.3 mSv for SVT and 23.8 mSv for AF CA procedures. The use of NMS, applying directly AV or VSL values, was not cost-effective for SVT CA for the most countries, whereas the use of an NMS during an AF CA seemed to be cost-effective for most of them.
In our analysis the cost-effectiveness of the systematic use of NMSs strongly depended on the AV and VSL values considered. Nonetheless, the approach seemed to be cost-effective only during AF CA procedures.
本研究旨在评估采用 3D 无射线导航系统（NMS）进行导管消融（CA）的成本效益。
本研究纳入了 2007 年至 2016 年间行室上性心动过速（SVT）CA 和心房颤动（AF）CA 的患者。将参考年份（2007 年）与两种术式的相应年份进行比较，以获得患者暴露于 NMS 时的最大优化。我们比较了 2007 年单纯使用射线透视进行的所有 SVT CA（I 组）和 2011 年同时使用射线透视和 NMS 进行的所有 SVT CA（II 组）的数据。还对 2007 年进行的 AF CA（III 组）和 2012 年进行的 AF CA（IV 组）进行了重要比较，两组患者均使用 NMS 治疗，但 NMS 的软件和硬件版本不同。进行了两种成本效益分析。第一种方法基于α值（AV）：AV 是避免单位暴露的货币参考值，以美元/人·毫西弗表示。第二种方法基于生命统计价值（VSL）：VSL 不代表一个人的生命的成本价值，而是一个社区愿意支付的金额，以降低一个人的死亡风险。从这两种方法中估算的成本与在我们的电生理实验室进行该类型手术时使用 NMS 的实际额外成本进行了比较。
NMS 的使用使 SVT 和 AF CA 手术的有效剂量分别降低了约 2.3 mSv 和 23.8 mSv。对于大多数国家来说，使用 NMS 进行 SVT CA 的成本效益并不高，直接应用 AV 或 VSL 值，而在 AF CA 中使用 NMS 似乎对大多数国家来说具有成本效益。
在我们的分析中，NMS 的系统使用的成本效益强烈取决于所考虑的 AV 和 VSL 值。尽管如此，这种方法似乎仅在 AF CA 手术中具有成本效益。
