Radiofrequency Catheter Ablation Versus Cryoballoon Ablation in the Treatment of Paroxysmal Atrial Fibrillation: A Cost-effectiveness Analysis in China

Sun, Xuerong; He, Shu-Nan; Lin, Zhidan; Zhang, Lei; Wang, Yanjiang; Zeng, Lijun; Shi, Liang; Xuan, Jianwei; Tian, Ying; Yang, Xinchun; Liu, Xingpeng

doi:10.1016/j.clinthera.2018.11.008

Cited by 13 publications

(14 citation statements)

References 40 publications

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“…Previous studies comparing these two technologies in various countries also show controversial results. For example, studies by Murray et al (2018) in Germany and Sun et al (2019) in china confirmed our findings [ 9 , 31 ], in contrast, a study by Ming et al (2019) in China showed that CBA compared to RFA is the dominant strategy in the treatment of patients with AF due to lower cost and QALY values [ 15 ].…”

Section: Discussionsupporting

confidence: 86%

“…According to recent findings, ablation technologies are the most effective therapeutic methods to improve the status of patients with AF and have the highest effect on preserving cardiac sinus rhythm as well as improving quality of life [ 8 , 9 ], but besides, also have a different financial burden and risk load rather than other therapeutic methods.…”

Section: Introductionmentioning

confidence: 99%

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Cost-utility analysis of Cryoballoon ablation versus Radiofrequency ablation in the treatment of paroxysmal atrial fibrillation in Iran

et al. 2022

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Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia (Calkins H, et al. 2012). There are various methods to treat AF of which Ablation is one of the most effective. We aimed to assess the cost-utility of Cryoballoon ablation (CBA) compared to Radiofrequency ablation (RFA) to treat patients with paroxysmal AF in Iran. A cost-utility analysis was done using a decision-analytic model based on a lifetime Markov structure which was drawn considering the nature of interventions and the natural progress of the disease. Costs data were extracted from medical records of 47 patients of Shahid Rajaie Cardiovascular Medical Center in Tehran in 2019. Parameters and variables such as transition probabilities, risks related to side effects, mortality rates, and utility values were extracted from the available evidence. Deterministic and probabilistic sensitivity analysis was also done. TreeAge pro-2020 software was used in all stages of analysis. In the base case analysis, the CBA strategy was associated with higher cost and effectiveness than RFA, and the incremental cost-effectiveness ratio was $11,223 per Quality-adjusted life year (QALY), which compared to Iran’s GDP per capita as Willingness to pay threshold, CBA was not cost-effective. On the other hand, considering twice the GDP per capita as a threshold, CBA was cost-effective. Probabilistic sensitivity analysis confirmed the findings of base case analysis, showed that RFA was cost-effective and the probability of cost-effectiveness was 59%. One-way sensitivity analysis showed that the results of the study have the highest sensitivity to changes in the RFA cost variable. Results of sensitivity analysis showed that the cost-effectiveness results were not robust and are sensitive to changes in variables changes. Primary results showed that CBA compared to RFA is not cost-effective in the treatment of AF considering one GDP per capita. But the sensitivity analysis results showed considerable sensitivity to changes of the ablation costs variable.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Cost-utility analysis of Cryoballoon ablation versus Radiofrequency ablation in the treatment of paroxysmal atrial fibrillation in Iran

et al. 2022

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“…The age-specific mortality rates were retrieved from a nationwide survey conducted in China [ 24 ]. The relative risk of death (with vs without GIB) was 3.5, with a range of 2.8 to 4.2 [ 25 ]. The mortality of GIB was calculated using age-specific mortality and the relative risk [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Mobile Health–Based Integrated Care for Atrial Fibrillation: Model Development and Data Analysis

Luo¹,

Xu²,

Ming³

et al. 2022

J Med Internet Res

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Background Mobile health (mHealth) technology is increasingly used in disease management. Using mHealth tools to integrate and streamline care has improved clinical outcomes of patients with atrial fibrillation (AF). Objective The aim of this study was to investigate the potential clinical and health economic outcomes of mHealth-based integrated care for AF from the perspective of a public health care provider in China. Methods A Markov model was designed to compare outcomes of mHealth-based care and usual care in a hypothetical cohort of patients with AF in China. The time horizon was 30 years with monthly cycles. Model outcomes measured were direct medical cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to examine the robustness of the base-case results. Results In the base-case analysis, mHealth-based care gained higher QALYs of 0.0730 with an incurred cost of US $1090. Using US $33,438 per QALY (three times the gross domestic product) as the willingness-to-pay threshold, mHealth-based care was cost-effective, with an ICER of US $14,936 per QALY. In one-way sensitivity analysis, no influential factor with a threshold value was identified. In probabilistic sensitivity analysis, mHealth-based care was accepted as cost-effective in 92.33% of 10,000 iterations. Conclusions This study assessed the expected cost-effectiveness of applying mHealth-based integrated care for AF according to a model-based health economic evaluation. The exploration suggested the potential cost-effective use of mHealth apps in streamlining and integrating care via the Atrial fibrillation Better Care (ABC) pathway for AF in China. Future economic evaluation alongside randomized clinical trials is highly warranted to verify the suggestion and investigate affecting factors such as geographical variations in patient characteristics, identification of subgroups, and constraints on local implementation.

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“…The cost of HF was derived from China Health Statistics Yearbook 2020 ( 26 ). Post-HF cost was based on a pharmacoeconomic study published by Sun et al ( 27 ).…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Dronedarone and Amiodarone for the Treatment of Chinese Patients With Atrial Fibrillation

Zhang

Ren

Wang

et al. 2021

Front. Public Health

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Background: Atrial fibrillation (AF) is one of the most common arrhythmias in clinical practice, which brings great economic burden to patients. This study evaluated the economics of the new antiarrhythmic drug dronedarone and provides suggestions for allocation of health resources.Methods: Amiodarone was selected as the control group, and the Markov model of AF was established using nine states. The total cost and quality-adjusted life year (QALY) of dronedarone and amiodarone groups were calculated and compared. The incremental cost effectiveness ratio (ICER) value was calculated and compared with the willingness to pay (WTP) and the sensitivity analyses was conducted.Results: For China's healthcare system, the ICER of the dronedarone group compared with the amiodarone group was RMB 81,741 Yuan/QALY, which is lower than the current recommended WTP (3 times GDP per capita). Sensitivity analyses showed that the model was robust, and the drug price of dronedarone significantly impacted the results.Conclusions: Compared with amiodarone, dronedarone is more economical in the Chinese healthcare system. However, due to the lack of data on the Chinese population for some parameters, the model needs further improvement and discussion. Real-world studies on the effects of dronedarone on Chinese patients with AF would be beneficial.

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Radiofrequency Catheter Ablation Versus Cryoballoon Ablation in the Treatment of Paroxysmal Atrial Fibrillation: A Cost-effectiveness Analysis in China

Cited by 13 publications

References 40 publications

Cost-utility analysis of Cryoballoon ablation versus Radiofrequency ablation in the treatment of paroxysmal atrial fibrillation in Iran

Cost-utility analysis of Cryoballoon ablation versus Radiofrequency ablation in the treatment of paroxysmal atrial fibrillation in Iran

Cost-Effectiveness of Mobile Health–Based Integrated Care for Atrial Fibrillation: Model Development and Data Analysis

Cost-Effectiveness of Dronedarone and Amiodarone for the Treatment of Chinese Patients With Atrial Fibrillation

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