Kim Woojin, Kim Min, Kim Yun Tae, Park Woongbi, Kim Jin-Bae, Kim Changsoo, Joung Boyoung
Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea.
Front Cardiovasc Med. 2023 Jan 24;10:1062578. doi: 10.3389/fcvm.2023.1062578. eCollection 2023.
Ablation-based treatment has emerged as an alternative rhythm control strategy for symptomatic atrial fibrillation (AF). Recent studies have demonstrated the cost-effectiveness of ablation compared with medical therapy in various circumstances. We assessed the economic comparison between ablation and medical therapy based on a nationwide real-world population.
For 192,345 patients with new-onset AF (age ≥ 18 years) identified between August 2015 and July 2018 from the Korean Health Insurance Review and Assessment Service (HIRA) database, medical resource use data were collected to compare AF patients that underwent ablation ( = 2,131) and those administered antiarrhythmic drugs ( = 8,048). Subsequently, a Markov chain Monte Carlo model was built. The patients had at least one risk factor for stroke, and the base-case used a 20-year time horizon, discounting at 4.5% annually. Transition probabilities and costs were estimated using the present data, and utilities were derived from literature review. The costs were converted to US $ (2019). Sensitivity analyses were performed using probabilistic and deterministic methods. The net costs and quality-adjusted life years (QALY) for antiarrhythmic drugs and ablation treatments were $37,421 and 8.8 QALYs and $39,820 and 9.3 QALYs, respectively. Compared with antiarrhythmic drugs, incremental cost-effectiveness ratio of ablation was $4,739/QALY, which is lower than the willingness-to-pay (WTP) threshold of $32,000/QALY.
In symptomatic AF patients with a stroke risk under the age of 75 years, ablation-based rhythm control is potentially a more economically attractive option compared with antiarrhythmic drug-based rhythm control in Korea.
基于消融的治疗已成为有症状心房颤动（AF）的一种替代节律控制策略。最近的研究表明，在各种情况下，消融与药物治疗相比具有成本效益。我们基于全国范围的真实世界人群评估了消融与药物治疗之间的经济学比较。
从韩国健康保险审查与评估服务（HIRA）数据库中识别出2015年8月至2018年7月期间的192,345例新发房颤患者（年龄≥18岁），收集医疗资源使用数据以比较接受消融治疗的房颤患者（n = 2,131）和接受抗心律失常药物治疗的患者（n = 8,048）。随后，构建了马尔可夫链蒙特卡罗模型。这些患者至少有一个中风危险因素，基础病例采用20年的时间范围，每年贴现率为4.5%。使用当前数据估计转移概率和成本，并从文献综述中得出效用值。成本换算为美元（2019年）。采用概率和确定性方法进行敏感性分析。抗心律失常药物和消融治疗的净成本和质量调整生命年（QALY）分别为37,421美元和8.8 QALY以及39,820美元和9.3 QALY。与抗心律失常药物相比，消融的增量成本效益比为4,739美元/QALY，低于支付意愿（WTP）阈值32,000美元/QALY。
在韩国，对于年龄在75岁以下有中风风险的有症状房颤患者，基于消融的节律控制与基于抗心律失常药物的节律控制相比，可能是一种在经济上更具吸引力的选择。
