Cost-Effectiveness Analysis of Pulsed Field Ablation Versus Radiofrequency Ablation and Cryoablation for Paroxysmal Atrial Fibrillation in China
Author(s)
Youqi Fan, PhD1, Ye Wang, PhD2, Yifei Jian, MS3, Yue Gao, MPH3, Shuting Chen, MS3, Jianwei Xuan, PhD3, Hesheng Hu, PhD2.
1Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, 2Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China, 3Health Economics Institute, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China.
1Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, 2Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China, 3Health Economics Institute, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China.
Presentation Documents
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)