OBJECTIVES : The contact-force catheter Thermocool SmartTouch® (ST), and ST guided by a novel lesion-quality marker ablation index (AI+ST) were both associated with improved outcomes than previous technologies in radiofrequency catheter ablation (RFCA). The second-generation cryoballoon (CB) ablation showed improved effectiveness and safety comparing with first-generation CB. A recent meta-analysis compared the effectiveness of these latest ablation devices. This study aimed to evaluate the cost effectiveness of AI+ST versus ST and the 2^nd-CB in atrial fibrillation (AF) patients from third-party payer's perspective in China

METHODS : A two-part model was developed to estimate the cost-effectiveness of the three technologies mentioned above. The short-term part was a decision-tree (1 year) including surgery-related complications. The long-term one was a Markov chain (up to lifetime) including the health states of normal sinus rhythms, AF recurrence, heart failure, stroke, post stroke, intracranial hemorrhages (ICH), post ICH, myocardial infarction (MI), post MI, gastrointestinal bleeding and death. Clinical outcomes, utility and cost data were obtained from published studies. The model calculated quality-adjusted life-years (QALYs) and total costs per patient. Incremental cost-effectiveness ratio (ICER) was calculated to examine the cost-effectiveness. Sensitivity analyses were conducted to assess the uncertainty.

RESULTS : Captured by the lifetime Markov model plus 1-year decision-tree model, the total costs per patient for AI+ST vs. ST vs. the 2^nd-CB groups were ¥108,222 ($15,526) vs. ¥110,816 ($15,898) vs. ¥121,520($17,433), while the QALY gained were 8.28 vs. 8.22 vs. 8.06 respectively. The ICER was ¥-43,799/QALY ($-6,283/QALY) for AI+ST vs. ST and ¥-59,538/QALY ($-8,541/QALY) for AI+ST vs. the 2nd-CB, which indicated the AI+ST group was dominant to ST and the 2^nd-CB groups for its less cost and better QALY gained. The sensitivity analyses confirmed the robustness of the results

CONCLUSIONS : Compared with ST and the 2^nd-CB, AI+ST group was cost saving for the treatment of AF in China