OBJECTIVES

: To compare the cost-effectiveness of antiarrhythmic drugs (AAD), radiofrequency catheters guided by ablation index (RFAI), and 2nd-generation cryoballoon catheters (CB2) in treating atrial fibrillation (AF).

METHODS

: A discrete event simulation (DES) model was developed and used to simulate the clinical journey of three cohorts of 10,000 individual paroxysmal AF patients. At the beginning of the simulation, each cohort was assigned to receive one of three initial interventions: AAD, CB2, or RFAI. AF recurrence, AF progression, stroke, intracranial hemorrhage (ICH), myocardial infarction (MI), heart failure (HF), and death were the clinical events explicitly modeled in the simulation based on literature-reported risk distributions. Utility values specific to the Chinese population and the cost information specific for the Chinese healthcare system were also obtained from previously published studies. Each patient’s direct medical costs and quality-adjusted life years (QALYs) were tracked with clinical events during the simulation until the patient either expired or reached the maximum simulation time of 30 years.

RESULTS

: All patients were initialized at 55 years of age with their initial CHA2DS2VASC score set to 2. AAD, CB2, and RFAI cohort patients on average accumulated 4.77, 5.76, and 6.54 QALYs, respectively. The average total direct medical cost was $10,568.06 for the AAD cohort, $22,829.46 for the CB2 cohort, and $20,546.08 for the RFAI cohort. RFAI was the dominant strategy when compared against CB2 with its lower cost and better outcome. The incremental cost effectiveness ratio (ICER) for RFAI vs AAD is $5641.37/QALY.

CONCLUSIONS

: The DES model demonstrates that RFAI is a more cost-effective intervention than AAD for treating AF in China when assuming an ICER threshold of $10,099 (nominal per capita GDP for China in 2019). Among the two ablation interventions evaluated in this study, RFAI dominated CB2 by delivering a better outcome at a lower total cost.