Chen Yang, Gomes Manuel, Garcia Jason V, Hunter Ross J, Chow Anthony W, Dhinoja Mehul, Schilling Richard J, Lowe Martin, Lambiase Pier D
Cardiology, Barts Health NHS Trust, London, UK.
Institute of Cardiovascular Science, University College London, London, UK.
Open Heart. 2020 Jan 28;7(1):e001155. doi: 10.1136/openhrt-2019-001155. eCollection 2020.
Catheter ablation is an important treatment for ventricular tachycardia (VT) that reduces the frequency of episodes of VT. We sought to evaluate the cost-effectiveness of catheter ablation versus antiarrhythmic drug (AAD) therapy.
A decision-analytic Markov model was used to calculate the costs and health outcomes of catheter ablation or AAD treatment of VT for a hypothetical cohort of patients with ischaemic cardiomyopathy and an implantable cardioverter-defibrillator. The health states and input parameters of the model were informed by patient-reported health-related quality of life (HRQL) data using randomised clinical trial (RCT)-level evidence wherever possible. Costs were calculated from a 2018 UK perspective.
Catheter ablation versus AAD therapy had an incremental cost-effectiveness ratio (ICER) of £144 150 (€161 448) per quality-adjusted life-year gained, over a 5-year time horizon. This ICER was driven by small differences in patient-reported HRQL between AAD therapy and catheter ablation. However, only three of six RCTs had measured patient-reported HRQL, and when this was done, it was assessed infrequently. Using probabilistic sensitivity analyses, the likelihood of catheter ablation being cost-effective was only 11%, assuming a willingness-to-pay threshold of £30 000 used by the UK's National Institute for Health and Care Excellence.
Catheter ablation of VT is unlikely to be cost-effective compared with AAD therapy based on the current randomised trial evidence. However, better designed studies incorporating detailed and more frequent quality of life assessments are needed to provide more robust and informed cost-effectiveness analyses.
导管消融术是治疗室性心动过速（VT）的重要方法，可减少VT发作频率。我们旨在评估导管消融术与抗心律失常药物（AAD）治疗的成本效益。
采用决策分析马尔可夫模型，计算针对一组假设的缺血性心肌病且植入了植入式心律转复除颤器的患者进行VT导管消融术或AAD治疗的成本和健康结果。模型的健康状态和输入参数尽可能依据随机临床试验（RCT）水平的证据，由患者报告的健康相关生活质量（HRQL）数据提供信息。成本从2018年英国的角度进行计算。
在5年的时间范围内，与AAD治疗相比，导管消融术每获得一个质量调整生命年的增量成本效益比（ICER）为144150英镑（161448欧元）。这一ICER是由AAD治疗和导管消融术在患者报告的HRQL方面的微小差异驱动的。然而，六项RCT中只有三项测量了患者报告的HRQL，而且即使进行了测量，频率也很低。使用概率敏感性分析，假设英国国家卫生与保健优化研究所采用的支付意愿阈值为30000英镑，导管消融术具有成本效益的可能性仅为11%。
基于目前的随机试验证据，与AAD治疗相比，VT导管消融术不太可能具有成本效益。然而，需要设计更完善的研究，纳入详细且更频繁的生活质量评估，以提供更有力、更明智的成本效益分析。
