Modelling the lifetime cost-effectiveness of catheter ablation for atrial fibrillation with heart failure
Modelling the lifetime cost-effectiveness of catheter ablation for atrial fibrillation with heart failure
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DOI：
10.1136/bmjopen-2019-031033
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发表时间：
2019-09-01
期刊：
影响因子：
2.9
通讯作者：
Moodie, Marj
中科院分区：
文献类型：
--
作者：
Gao, Lan;Moodie, Marj
目的：与常规药物治疗相比，评估这种干预对合并心房颤动（AF）和心力衰竭（HF）患者的成本-效果。设计构建了包含两种健康状态（即活着或死了）的马尔可夫模型。转移概率直接来源于关键随机对照试验的已发表的Kaplan-Meier曲线，并使用推荐的方法在队列的一生中进行外推。包括导管消融、门诊咨询、住院、药物和检查的费用。资源使用和单位成本来源于政府网站或出版的文献。采用了生命周期和医疗保健系统的视角。所有的成本和福利都以每年3%的折现率计算。围绕关键模型参数进行确定性（DSA）和概率敏感性分析（PSA），以检验基本情况结果的稳健性。参与者：一组对抗心律失常治疗有抵抗力的伴有房颤和心衰的澳大利亚患者。干预措施：导管消融与药物治疗。结果导管消融术的人均费用为A44 377美元，而单独药物治疗的人均费用为A28 506美元。与药物治疗组的4.30 QALYs和6.53 LY相比，导管消融组分别增加了4.58质量调整生命年（QALYs）和6.99 LY。增量成本-效果比为55 942美元/QALY或35 020美元/LY。DSA显示结果对消融费用和时间范围高度敏感。PSA的结果与基本情况非常一致。结论：对抗心律失常药物无效的系统性阵发性或持续性房颤患者进行导管消融治疗成本较高，但获益较大。与单独的药物治疗相比，从澳大利亚医疗保健系统的角度来看，这种干预并不具有成本效益。
Objectives Assessing the cost-effectiveness credentials of this intervention in patients with concomitant atrial fibrillation (AF) and heart failure (HF) compared with usual medical therapy.Design A Markov model comprising two health states (ie, alive or dead) was constructed. The transition probabilities were directly derived from published Kaplan-Meier curves of the pivotal randomised controlled trial and extrapolated over the cohort's lifetime using recommended methods. Costs of catheter ablation, outpatient consultations, hospitalisation, medications and examinations were included. Resource use and unit costs were sourced from government websites or published literature. A lifetime horizon and a healthcare system perspective were taken. All costs and benefits were discounted at 3% annually. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) were run around the key model parameters to test the robustness of the base case results.Participants A hypothetical Australian cohort of patients with concomitant AF and HF who are resistant to antiarrhythmic treatment.Interventions Catheter ablation versus medical therapy.Results The catheter ablation was associated with a cost of $A44 377 per person, in comparison to $A28 506 for the medical therapy alone over a lifetime. Catheter ablation contributed to 4.58 quality-adjusted life years (QALYs) and 6.99 LY gains compared with 4.30 QALYs and 6.53 LY gains, respectively, in the medical therapy arm. The incremental cost-effectiveness ratio was $A55 942/QALY or $A35 020/LY. The DSA showed that results were highly sensitive to costs of ablation and time horizon. The PSA yielded very consistent results with the base case.Conclusions Offering catheter ablation procedure to patients with systematic paroxysmal or persistent AF who failed to respond to antiarrhythmic drugs was associated with higher costs, greater benefits. When compared with medical therapy alone, this intervention is not cost-effective from an Australia healthcare system perspective.