Cost-Effectiveness Analysis of Pulsed Field Ablation Versus Radiofrequency Ablation and Cryoablation for Paroxysmal Atrial Fibrillation in China
Moderator
Yue Gao, Health Economic Research Institute, School of Pharmaceutical Sciences, Sun Yat-Sen University, Shanghai, China
Speakers
Youqi Fan; Ye Wang; Yifei Jian, Shanghai Centennial Scientific Co., Ltd, Shanghai, China; Shuting Chen, China; Jianwei Xuan, PhD, China Southern Medical University, School of Pharmaceutical Sciences, Guangzhou, China; Hesheng Hu
OBJECTIVES: To evaluate the cost-utility of pulsed field ablation compared with radiofrequency ablation and cryoablation, respectively, in Chinese patients with paroxysmal atrial fibrillation.
METHODS: Patients with paroxysmal atrial fibrillation at different levels of atrial arrhythmia (AA) burden (<0.1%, 0.1-9.9%, ≥10%) may experience various AA burden states after undergoing ablation. A decision tree model was developed to simulate this process from a healthcare perspective, where patients could undergo a repeat ablation or experience a non-fatal stroke. Transition probabilities, clinical outcome and quality of life data were obtained from published sources and confirmed by expert physicians. Cost data were estimated from a survey of clinicians at tertiary hospitals, based on actual clinical practices. The uncertainty of results was explored through one-way sensitivity analysis and probabilistic sensitivity analysis by Monte Carlo simulation.
RESULTS: Compared with radiofrequency ablation and cryoablation, pulsed field ablation dominates both in incremental quality-adjusted life years (QALYs) gained and cost savings, assuming identical direct costs for ablation procedure. Pulsed field ablation saved ¥2,178 (¥71,839 vs. ¥74,017) and gained 0.0145 more QALYs (0.8488 vs. 0.8343) than radiofrequency ablation. This includes savings of ¥324 in post-operative complication management, ¥1,118 in repeat ablation surgery costs weighted by the number of procedures, ¥327 in non-fatal stroke-related expenses, and ¥409 in long-term medication costs for antiarrhythmic and anticoagulant drugs. Pulsed field ablation saved ¥1,633 (¥71,839 vs. ¥73,472) and gained 0.0017 more QALYs (0.8488 vs. 0.8471) than cryoablation. This includes savings of ¥169.44 in post-operative complication management, ¥1,264 in repeat ablation surgery costs weighted by the number of procedures, ¥178 in non-fatal stroke-related expenses, and ¥22 in long-term medication costs for antiarrhythmic and anticoagulant drugs.
CONCLUSIONS: Pulsed field ablation was likely to be more cost effective than both radiofrequency ablation and cryoablation in China.
METHODS: Patients with paroxysmal atrial fibrillation at different levels of atrial arrhythmia (AA) burden (<0.1%, 0.1-9.9%, ≥10%) may experience various AA burden states after undergoing ablation. A decision tree model was developed to simulate this process from a healthcare perspective, where patients could undergo a repeat ablation or experience a non-fatal stroke. Transition probabilities, clinical outcome and quality of life data were obtained from published sources and confirmed by expert physicians. Cost data were estimated from a survey of clinicians at tertiary hospitals, based on actual clinical practices. The uncertainty of results was explored through one-way sensitivity analysis and probabilistic sensitivity analysis by Monte Carlo simulation.
RESULTS: Compared with radiofrequency ablation and cryoablation, pulsed field ablation dominates both in incremental quality-adjusted life years (QALYs) gained and cost savings, assuming identical direct costs for ablation procedure. Pulsed field ablation saved ¥2,178 (¥71,839 vs. ¥74,017) and gained 0.0145 more QALYs (0.8488 vs. 0.8343) than radiofrequency ablation. This includes savings of ¥324 in post-operative complication management, ¥1,118 in repeat ablation surgery costs weighted by the number of procedures, ¥327 in non-fatal stroke-related expenses, and ¥409 in long-term medication costs for antiarrhythmic and anticoagulant drugs. Pulsed field ablation saved ¥1,633 (¥71,839 vs. ¥73,472) and gained 0.0017 more QALYs (0.8488 vs. 0.8471) than cryoablation. This includes savings of ¥169.44 in post-operative complication management, ¥1,264 in repeat ablation surgery costs weighted by the number of procedures, ¥178 in non-fatal stroke-related expenses, and ¥22 in long-term medication costs for antiarrhythmic and anticoagulant drugs.
CONCLUSIONS: Pulsed field ablation was likely to be more cost effective than both radiofrequency ablation and cryoablation in China.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE103
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)