Iroegbu Chukwuemeka Daniel, Chen Wangping, Wu Xun, Cheng Luo, Zhang Hao, Wu Ming, Zhao Yuan, Liu Li Ming, Yang Jinfu
Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China.
Cardiovasc Diagn Ther. 2020 Oct;10(5):1200-1215. doi: 10.21037/cdt-20-574.
The pursuit of a clearer understanding of the pathogenesis of atrial fibrillation (AFib) and the development of new technology has resulted in a surge of interest in the surgical ablation for AFib. Here, we report our 8-year experience in the surgical treatment and management of AFib alongside, evaluating the cost-effectiveness in southern Mainland China over a 1-year follow-up.
Data of 3,068 patients from March 2011 through June 2019 was retrospectively extracted from The Provincial National Cardiac Database of Xiangya Second Hospital. The activities considered (and costs calculated) were outpatient consultations, hospital admissions, and drug treatment. Quality of life (QoL) questionnaires were also carried out to assess whether concomitant AFib correction procedures increase risk in patients, or improve patient's QoL.
A total of 3,068 patients completed the questionnaires at a minimum of one time-point during the follow-up. The total cost was combined to obtain incremental costs per quality-adjusted life-years (QALYs). The total costs of the AFib catheter ablation group were remarkably higher compared to surgery as usual group. The incremental cost-effectiveness ratio was $76,513,227 (¥542,287,667) per QALY, with an acceptability line graph for cost at 43%.
AFib is an extraordinarily costly and worrisome public health problem. Precision medicine is vital as it provides a platform for the clinical translation of targeted interventions that are designed to help treat and prevent AFib. Thus, to improve the QoL expectancy outcome(s), both therapeutic and surgical interventions should be aimed at addressing the underlying heart disease rather than restoring sinus rhythm.
对心房颤动（AFib）发病机制的更清晰理解以及新技术的发展，引发了人们对AFib外科消融术的浓厚兴趣。在此，我们报告我们在AFib外科治疗与管理方面的8年经验，并评估中国内地南部1年随访期内的成本效益。
回顾性提取2011年3月至2019年6月湘雅二医院省级国家心脏数据库中3068例患者的数据。所考虑的活动（以及计算的成本）包括门诊咨询、住院和药物治疗。还进行了生活质量（QoL）问卷调查，以评估同时进行的AFib矫正手术是否会增加患者风险，或改善患者的QoL。
共有3068例患者在随访期间至少在一个时间点完成了问卷调查。将总成本合并以获得每质量调整生命年（QALY）的增量成本。与常规手术组相比，AFib导管消融组的总成本显著更高。每QALY的增量成本效益比为76513227美元（542287667元人民币），成本可接受线图为43%。
AFib是一个极其昂贵且令人担忧的公共卫生问题。精准医学至关重要，因为它为旨在帮助治疗和预防AFib的靶向干预措施的临床转化提供了一个平台。因此，为了改善预期的QoL结果，治疗和手术干预都应旨在解决潜在的心脏病，而不是恢复窦性心律。
