Wazni Oussama, Moss Joe, Kuniss Malte, Andrade Jason, Chierchia Gian Battista, Mealing Stuart, Mburu Waruiru, Sale Alicia, Kaplon Rachelle, Ismyrloglou Eleni, Bromilow Tom, Lane Emily, Lewis Damian, Reynolds Matthew R
Department of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, Ohio.
York Health Economics Consortium, York, United Kingdom.
Heart Rhythm O2. 2023 Jul 27;4(9):528-537. doi: 10.1016/j.hroo.2023.07.007. eCollection 2023 Sep.
Three recent randomized controlled trials have demonstrated that, as an initial rhythm control strategy, first-line cryoballoon ablation (cryoablation) reduces atrial arrhythmia recurrence compared with antiarrhythmic drugs (AADs) in patients with symptomatic paroxysmal atrial fibrillation (PAF).
The study sought to evaluate the cost-effectiveness of first-line cryoablation compared with first-line AADs for treating symptomatic PAF from a U.S. Medicare payer perspective.
Individual patient-level data from 703 participants with PAF enrolled into the Cryo-FIRST (NCT01803438), STOP AF First (NCT03118518), and EARLY-AF (NCT02825979) trials were used to derive parameters for the cost-effectiveness model. The cost-effectiveness model used a hybrid decision tree and Markov structure. The decision tree had a 1-year time horizon and was used to inform the initial health state allocation in the first cycle of the Markov model. The Markov model used a 40-year time horizon (3-month cycle length). Health benefits were expressed in quality-adjusted life years (QALYs). Costs and benefits were discounted at 3% per year.
Cryoablation was estimated to yield higher QALYs (+0.17) and higher costs (+$4274) per patient over a 40-year time horizon than AADs. Ultimately, this produced an average incremental cost-effectiveness ratio of $24,637 per QALY gained. Independent of initial treatment, individuals were expected to receive ∼1.2 ablations over a lifetime. There was a 45% relative reduction in time spent in atrial fibrillation health states for those initially treated with cryoablation compared with AADs.
Initial rhythm control with first-line cryoballoon ablation is highly cost-effective compared with first-line AADs from a U.S. Medicare payer perspective.
最近三项随机对照试验表明，作为一种初始节律控制策略，在有症状的阵发性心房颤动（PAF）患者中，与抗心律失常药物（AADs）相比，一线冷冻球囊消融术（冷冻消融）可降低房性心律失常的复发率。
本研究旨在从美国医疗保险支付方的角度评估一线冷冻消融与一线AADs治疗有症状PAF的成本效益。
来自Cryo-FIRST（NCT01803438）、STOP AF First（NCT03118518）和EARLY-AF（NCT02825979）试验的703例PAF参与者的个体患者水平数据用于推导成本效益模型的参数。成本效益模型采用混合决策树和马尔可夫结构。决策树的时间范围为1年，用于为马尔可夫模型第一个周期的初始健康状态分配提供信息。马尔可夫模型的时间范围为40年（周期长度为3个月）。健康效益以质量调整生命年（QALYs）表示。成本和效益按每年3%进行贴现。
在40年的时间范围内，估计冷冻消融术比AADs能为每位患者带来更高的QALYs（+0.17）和更高的成本（+$4274）。最终，这产生了每获得一个QALY平均增量成本效益比为24,637美元。与初始治疗无关，预计个体一生中会接受约1.2次消融。与AADs相比，最初接受冷冻消融治疗的患者在房颤健康状态下花费的时间相对减少了45%。
从美国医疗保险支付方的角度来看，与一线AADs相比，一线冷冻球囊消融术进行初始节律控制具有很高的成本效益。
