Department of Internal Medicine, Center for Electrophysiology, Rhythm Disorders and Electro-Mechanical Interventions, University of Cincinnati, Cincinnati, Ohio, USA.
Franchise Health Economics and Market Access, Johnson and Johnson Medical Devices, Irvine, California, USA.
BMJ Open. 2020 Aug 5;10(8):e035499. doi: 10.1136/bmjopen-2019-035499.
To compare real-world clinical and economic outcomes among atrial fibrillation (AF) patients undergoing cardiac ablation with the contact force-sensing porous tip THERMOCOOL SMARTTOUCH SF (STSF) catheter versus the Arctic Front Advance Cryoballoon (AFA-CB) catheter.
Retrospective, observational cohort study.
Premier Healthcare Database (PHD), between 1 September 2016 and 30 June 2018.
Patients with AF (≥18 years) were included if they had an index ablation procedure performed using the STSF catheter or AFA-CB catheter at a US hospital that consistently provided inpatient and outpatient data to PHD in the 12-month preindex period. Using 1:1 propensity score matching, patient groups were matched on study covariates.
Cost, length of stay (LOS), readmissions, direct current cardioversion (DCCV) and reablation outcomes were compared between matched cohorts of STSF and AFA-CB patients.
A total of 3015 patients with AF met the study criteria, of which 1720 had ablation using the STSF catheter and 1295 had ablation using the AFA-CB catheter. In the propensity-matched sample, patients receiving ablation with the STSF catheter had ~17% lower total costs (US$23 096 vs US$27 682, p≤0.0001) and ~27% lower supply costs (US$10 208 vs US$13 816, p≤0.0001) versus patients receiving ablation with the AFA-CB catheter. A significantly lower likelihood of 4-month to 6-month cardiovascular-related readmission (OR 0.460, 95% CI 0.220 to 0.959) was associated with the STSF catheter versus the AFA-CB catheter. No significant differences in LOS, room and board cost, 4-month to 6-month all-cause and AF-related readmissions, DCCV and reablation were observed among technologies. Sensitivity analysis restricting patient sample by provider ablation volume demonstrated similar results.
Lower index ablation total and supply costs were observed among patients with AF undergoing cardiac catheter ablation using the STSF catheter versus the AFA-CB catheter.
比较使用接触力感应多孔尖端 THERMOCOOL SMARTTOUCH SF（STSF）导管与北极前线冷冻球囊（AFA-CB）导管进行心脏消融的心房颤动（AF）患者的真实临床和经济结局。
回顾性观察队列研究。
Premier Healthcare Database（PHD），2016 年 9 月 1 日至 2018 年 6 月 30 日。
如果患者在使用 STSF 导管或 AFA-CB 导管进行索引消融的美国医院中有 12 个月的索引前数据持续提供住院和门诊数据，并且年龄≥18 岁，则将患者纳入研究。使用 1：1 倾向评分匹配，根据研究协变量对患者组进行匹配。
比较了 STSF 和 AFA-CB 患者匹配队列之间的成本、住院时间（LOS）、再入院、直流电复律（DCCV）和再消融结果。
共有 3015 名 AF 患者符合研究标准，其中 1720 名患者接受 STSF 导管消融，1295 名患者接受 AFA-CB 导管消融。在倾向评分匹配样本中，接受 STSF 导管消融的患者总费用降低了约 17%（23096 美元 vs 27682 美元，p≤0.0001），供应成本降低了约 27%（10208 美元 vs 13816 美元，p≤0.0001），与接受 AFA-CB 导管消融的患者相比。与 AFA-CB 导管相比，STSF 导管与 4 至 6 个月心血管相关再入院的可能性显著降低（OR 0.460，95%CI 0.220 至 0.959）。两种技术之间的 LOS、房间和董事会费用、4 至 6 个月全因和 AF 相关再入院、DCCV 和再消融无显著差异。在按提供者消融量限制患者样本的敏感性分析中，观察到了类似的结果。
与 AFA-CB 导管相比，使用 STSF 导管进行心脏导管消融的 AF 患者的索引消融总费用和供应成本较低。
