Nitta Yoshimi, Nishimura Michiko, Shibahara Hidetoshi, Yamane Teiichi
Health Economics & Reimbursement Japan Abbott Medical Japan LLC Tokyo Japan.
CRECON Medical Assessment Inc Tokyo Japan.
J Arrhythm. 2024 Jun 9;40(4):802-814. doi: 10.1002/joa3.13055. eCollection 2024 Aug.
Previous studies have shown inconsistent results in clinical effectiveness between cryoballoon ablation (CBA) and radiofrequency ablation (RFA), and cost assessment between the procedures is important. The aim of this study was to evaluate the clinical effectiveness and cost-effectiveness between the procedures in patients with paroxysmal atrial fibrillation (AF) refractory to antiarrhythmic drug therapy.
A systematic review and meta-analysis were performed. The primary outcome for the meta-analysis was long-term AF recurrence. Following the results of the meta-analysis, the cost-effectiveness of CBA versus RFA in Japan was assessed.
The meta-analysis included 12 randomized controlled trials and six propensity-score matching cohort studies. AF recurrence was slightly lower in patients referred for CBA than for RFA, with an integrated risk ratio of 0.93 (95% confidence interval: 0.81-1.07) and an integrated hazard ratio of 0.96 (95% confidence interval: 0.77-1.19), but no significant difference was found. A cost-minimization analysis was conducted to compare the medical costs of CBA versus RFA because there was no significant difference in the risk of AF recurrence between the procedures. The estimated costs for CBA and RFA were JPY 4 858 544 (USD 32 390) and JPY 4 505 255 (USD 30 035), respectively, with cost savings for RFA of JPY 353 289 (USD 2355).
Our meta-analysis suggests that CBA provides comparable benefits with regard to AF recurrence compared with RFA, as shown in previous studies. Although the choice of treatment should be based on patient and treatment characteristics, RFA was shown that it might be cost saving as compared to CBA.
先前的研究表明，冷冻球囊消融术（CBA）和射频消融术（RFA）在临床疗效上的结果并不一致，对这两种手术进行成本评估很重要。本研究的目的是评估对阵发性心房颤动（AF）抗心律失常药物治疗无效的患者，这两种手术的临床疗效和成本效益。
进行了系统评价和荟萃分析。荟萃分析的主要结果是长期房颤复发率。根据荟萃分析的结果，评估了日本CBA与RFA的成本效益。
荟萃分析纳入了12项随机对照试验和6项倾向评分匹配队列研究。接受CBA治疗的患者房颤复发率略低于接受RFA治疗的患者，综合风险比为0.93（95%置信区间：0.81-1.07），综合风险比为0.96（95%置信区间：0.77-1.19），但未发现显著差异。由于两种手术在房颤复发风险上无显著差异，因此进行了成本最小化分析以比较CBA与RFA的医疗成本。CBA和RFA的估计成本分别为4858544日元（32390美元）和4505255日元（30035美元），RFA节省成本353289日元（2355美元）。
我们的荟萃分析表明，与RFA相比，CBA在房颤复发方面提供了相当的益处，如先前研究所示。尽管治疗选择应基于患者和治疗特征，但结果表明，与CBA相比，RFA可能具有成本效益。
