School of Public Health, Fudan University, Shanghai, China.
Health Economics Research Institute, Sun Yat-sen University, Guangzhou, China.
Value Health. 2022 Jun;25(6):975-983. doi: 10.1016/j.jval.2021.10.014. Epub 2021 Dec 13.
To evaluate the lifetime cost-effectiveness of 3 widely used atrial fibrillation (AF) treatments from the perspectives of Chinese healthcare system: antiarrhythmic drugs (AADs), ThermoCool SmartTouch guided by ablation index (STAI), and second-generation cryoballoon (CB2).
A discrete event simulation (DES) model was implemented to compare the lifetime cost-effectiveness of AADs, STAI, and CB2. AF disease progression was explicitly modeled based on the Atrial Fibrillation Progression Trial clinical study results. The base-case analysis assumed that patients with paroxysmal AF (PAF) entered the model at the age of 55 years and had a CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ( > 65 = 1 point, > 75 = 2 points), Diabetes, previous Stroke/transient ischemic attack (2 points)-Vascular disease (peripheral arterial disease, previous myocardial infarction, aortic atheroma), Age 65 to 74 years, and Sex category) score of 2 for males and 3 for females. Model parameter uncertainties were incorporated throughout the DES simulation with full probabilistic model parameterization.
The lifetime cost-effectiveness evaluations showed that patients treated with AADs gained an average of 4.98 quality-adjusted life-years (QALYs) and 9.63 life-years (LYs) at an average cost of US dollar (USD) 15 374. Patients treated with CB2 gained 5.92 QALYs and 10.74 LYs at an average cost of USD 26 811. The STAI group gained an average of 6.55 QALYs and 11.57 LYs at an average cost of USD 24 722. The incremental cost-effectiveness ratios was USD 5927 and USD 12 167 per QALY for STAI versus AADs and CB2 versus AADs, respectively. Assuming the willingness-to-pay threshold for China is USD 30 390 per QALY, both ablation treatments will be cost-effective compared with AADs for patients with PAF.
The DES model demonstrated that catheter ablations are more cost-effective than AADs for patients with PAF under the healthcare system in China. Among catheter ablation technologies, STAI provides better outcomes at lower costs.
从中国医疗体系的角度评估三种广泛应用的心房颤动（AF）治疗方法的终生成本效益：抗心律失常药物（AAD）、基于消融指数的 ThermoCool SmartTouch（STAI）和第二代冷冻球囊（CB2）。
采用离散事件模拟（DES）模型比较 AAD、STAI 和 CB2 的终生成本效益。根据心房颤动进展试验的临床研究结果，明确建模 AF 疾病进展。基础案例分析假设阵发性 AF（PAF）患者在 55 岁时进入模型，CHA2DS2-VASc（充血性心力衰竭、高血压、年龄（>65=1 分，>75=2 分）、糖尿病、既往卒中/短暂性脑缺血发作[2 分] -血管疾病（外周动脉疾病、既往心肌梗死、主动脉粥样硬化）、年龄 65-74 岁和性别类别）评分男性为 2，女性为 3。通过完全概率参数化，在整个 DES 模拟过程中纳入模型参数不确定性。
终生成本效益评估表明，AAD 治疗组患者的平均获益为 4.98 个质量调整生命年（QALY）和 9.63 个生命年（LY），平均成本为 15374 美元。CB2 治疗组患者的平均获益为 5.92 QALY 和 10.74 LY，平均成本为 26811 美元。STAI 组患者的平均获益为 6.55 QALY 和 11.57 LY，平均成本为 24722 美元。STAI 相对于 AAD 和 CB2 相对于 AAD 的增量成本效益比分别为 5927 美元和 12167 美元/QALY。假设中国的意愿支付阈值为 30390 美元/QALY，则对于 PAF 患者，两种消融治疗均比 AAD 更具成本效益。
DES 模型表明，在我国医疗体系下，对于 PAF 患者，导管消融术比 AAD 更具成本效益。在导管消融技术中，STAI 以较低的成本提供更好的结果。
