OBJECTIVES: Catheter ablation (RFCA) procedure for AF has been widely applied in China, however, no published study has examined the cost effectiveness of catheter ablation in the Chinese setting. To determine the cost effectiveness of RFCA vs. anti-arrhythmic drugs in the treatment of Chinese AF patients from third-party payer perspective. METHODS: The cost effectiveness of RFCA was evaluated in comparison with anti-arrhythmic drugs (AADs). Outcomes in the model were captured as quality-adjusted life years (QALYs). A decision analytical model was constructed to evaluate the short-term and long-term cost effectiveness. The cost data were from a micro cost study based on real world Chinese hospital costs. Clinical effectiveness data were obtained from a prospective, non-randomized, single center study in China as well as literature review and the physician survey. RESULTS: In the short term and long term time horizons, the RFCA treatment arm incurred more costs than the AADs arm but also had more QALY improvement than the AADs arm. When compared RFCA with AADs, the ICERs were ¥66,763.91, ¥36,279.52 and ¥29,359.32 per QALY for 8, 15, and 20-year time horizons respectively. The sensitivity analyses demonstrated that the results were most sensitive to the changes in RFCA cost and CHADSscore among the variables tested. CONCLUSIONS: The present study provides the first cost-effectiveness analysis comparing these two most popular treatment strategies currently practiced in China. The study results support that RFCA is a cost effective therapy, when compared with anti-arrhythmic drugs, in the treatment of Chinese AF patients with ICERs lower than three times of per capita GDP in China. The results also demonstrated that the RFCA procedure is more cost effective in the longer time horizons.