COST-EFFECTIVENESS ANALYSIS OF RADIOFREQUENCY CATHETER ABLATION WITH SMARTTOUCH® VERSUS FIRST-GENERATION CRYOBALLOON ABLATION ON THE TREATMENT OF PAROXYSMAL ATRIAL FIBRILLATION PATIENTS IN CHINA
Author(s)
Zhang L1, Lin Z2, Jia Y3, Lyu R3, Tao L4, Xuan J4
1Shanghai Centennial Scientific Ltd., Shanghai, China, 2Shanghai Centennial Scientific, Shanghai, China, 3Johnson & Johnson Medical (China) Ltd., Shanghai, China, 4Sun Yat-Sen University, Guangzhou, China
OBJECTIVES: Clinical guidelines recommend pulmonary-vein isolation by means of radiofrequency catheter ablation (RFCA) or cryoballoon ablation (CB) as treatment for paroxysmal atrial fibrillation (PAF). While RFCA with SmartTouch® Catheter (ST) and the first-generation CB (CB-1) are widely-used in China, studies examining the cost-effectiveness of the two technologies are rare. This study was to determine the cost-effectiveness of ST vs. CB-1 in Chinese PAF patients from a payer’s perspective. METHODS: A two-part model was developed to estimate the cost-effectiveness of the two technologies. The short-term part was a decision-tree that included surgery-related complications within the first 18 months from discharge. The long-term (up to 20 years) part was a Markov chain including the health states of normal sinus rhythms, AF recurrence, stroke, post stroke, intracranial hemorrhages (ICH), post ICH, and gastrointestinal bleeding. Clinical and utility data were obtained from published literature. Cost data were collected from Chinese leading hospitals. The model calculated quality-adjusted life years (QALYs) and total costs per patient. Costs and QALYs were discounted by 3.5% annually. A one-way sensitivity analysis was conducted for all parameters. RESULTS: Captured by the 5-year, 10-year, and 20-year Markov model plus 18-month decision tree model, the total costs per patient for the ST vs. CB-1 groups were $14,717.17 vs. $16,662.94, $16,988.95 vs. $19,485.67 and $19,591.78 vs. $22,570.62, respectively; 5-year, 10-year, and 20-year QALYs for the ST vs. CB-1 groups were 4.23 vs. 4.22, 6.43 vs. 6.38 and 8.64 vs. 8.53, respectively. The result suggests dominant ICERs across all scenarios, indicating that ST, compared with CB-1, has better efficacy and lower overall costs. The one-way sensitivity analysis did not change the conclusion, indicating the robustness of the result. CONCLUSIONS: RFCA with ST is a dominant treatment of PAF in China compared to CB-1. This evidence supports the broad clinical application of RFCA with ST over CB-1.
Conference/Value in Health Info
2017-05, ISPOR 2017, Boston, MA, USA
Value in Health, Vol. 20, No. 5 (May 2017)
Code
PMD64
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Cardiovascular Disorders