is an employee of, and Diana Frame and Peter J. Mallow are consultants of, CTI Clinical Trial and Consulting Services, which is a consultant to Biosense Webster, the study sponsor. Mark M. Gallagher has received research funding from Attune Medical and has acted as a consultant and paid speaker for Boston Scientific and Cook Medical. Lisa W. M. Leung has received research support from Attune Medical.

Background: Radiofrequency catheter ablation (RFCA) is an established treatment for atrial fibrillation (AF) refractory to antiarrhythmic drugs. The economic value of RFCA in delaying disease progression has not been quantified. Methods: An individual-level, state-transition health economic model estimated the impact of delayed AF progression using RFCA versus antiarrhythmic drug treatment for a hypothetical sample of patients with paroxysmal AF. The model incorporated the lifetime risk of progression from paroxysmal AF to persistent AF, informed by data from the ATTEST (Atrial Fibrillation Progression Trial). The incremental effect of RFCA on disease progression was modeled over a 5-year duration. Annual crossover rates were also included for patients in the antiarrhythmic drug group to mirror clinical practice. Estimates of discounted costs and quality-adjusted life years asssociated with health care utilization, clinical outcomes, and complications were projected over patients’ lifetimes. Results: From the payer’s perspective, RFCA was superior to antiarrhythmic drug treatment with an estimated mean net monetary benefit per patient of $8516 ($148–$16 681), driven by reduced health care utilization, cost, and improved quality-adjusted life years. RFCA reduced mean (95% CI) per-patient costs by $73 (−$2700 to $2200), increased mean quality-adjusted life years by 0.084 (0.0–0.17) and decreased the mean number of cardiovascular-related health care encounters by 24%. Conclusions: RFCA is a dominant (less costly and more effective) treatment strategy for patients with AF, especially those with early AF for whom RFCA could delay progression to advanced AF. Increased utilization of RFCA—particularly among patients earlier in their disease progression—may provide clinical and economic benefits.

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Temperature changes and their distribution induced by 13.56-MHz radiofrequency (RF) heating of agar phantom and porcine and rabbit liver were investigated. It was possible to produce selective local heating of approximately 50°C in the RF field of 2 × 2 × 2 cm³ of the pig or rabbit liver. Coagulation necrosis after heating became pronounced and the margin between the coagulated lesion and normal tissue became clearer with time. Within 1 week after RF heating at 50°C for 20 min, the coagulated area was replaced selectively and totally by necrotic tissue.

Objectives: Nowadays, it is clear that correcting elevated LDL cholesterol (LDL-C) is an effective way to reduce CV event risk. This study assessed the cost-effectiveness of Alirocumab as add-on lipid-lowering therapy in high CV risk groups from the perspective of National Health Insurance in Taiwan. Methods: A Markov model, incorporating the disease progression of patients in terms of LDL-C level change, incidence of CV event and death, was used. Adult hyperlipidemia patients with high CV risk were included in the study. Intervention was the treatment using Alirocumab with high intensity statin as background therapy and compared to high intensity statin plus ezetimibe. Primary outcomes were direct medical cost, life-year, qualityadjusted life years (QALY), and incremental cost-effectiveness ratio (ICERs). To conduct simulation, we first set the cohort characteristics, including initial age, proportion of male, prevalence of diabetes and baseline LDL-C value based on the UK THIN data. Data related to treatment efficacy of statin, ezetimibe and Alirocumab, incidence of CV events, reduction of LDL-C level and health-related quality-of-life status were obtained from the ODYSSEY trial and published studies. The mortality of non-CV death was obtained the Taiwan's Death Registry data. Drug costs, CV event costs and CV death cost were obtained from Taiwan's National Health Insurance Claims data. Results: When compared to ezetimibe, hyperlipidemia patients with high CV risk received Alirocumab as add-on lipid lowering therapy gained 1.5 QALY at an additional cost of US$81,281.9, yielding an ICER of US$53,938.7 per QALY gained. Probabilistic senstivity analyses showed that when using 3 times of the GDP per capita as the threshold, the probability of Alirocumab being cost-effective was 74%. Conclusions: Using Alirocumab as an add-on treatment of hyperlipidemia.