医学
低温消融
心房颤动
随机对照试验
肺静脉
内科学
成本效益分析
质量调整寿命年
阵发性心房颤动
成本效益
心脏病学
烧蚀
风险分析(工程)
作者
Jason G. Andrade,Joe Moss,Malte Kuniss,Hamid Sadri,D. Oussama Wazni,Alicia Sale,Eleni Ismyrloglou,Gian‐Battista Chierchia,Rachelle E. Kaplon,Stuart Mealing,James Bainbridge,Tom Bromilow,E. Lane,Yaariv Khaykin
标识
DOI:10.1016/j.cjca.2023.11.019
摘要
The EARLY-AF (NCT02825979), STOP AF First (NCT03118518), and Cryo-FIRST (NCT01803438), randomized controlled trials (RCTs) demonstrated that cryoballoon pulmonary vein isolation reduces atrial fibrillation (AF) recurrence compared with antiarrhythmic drugs (AADs) in patients with symptomatic paroxysmal AF (PAF). This study developed a cost-effectiveness model (CEM) of first-line cryoablation compared with first-line AADs for PAF, from a Canadian healthcare payer's perspective.Data from the three RCTs were analysed to estimate key CEM parameters. The model structure used a decision tree for the first 12 months and a Markov model, with a three-month cycle length, for the remaining lifetime time horizon. Costs were set at 2023 Canadian dollars, health benefits were expressed as quality-adjusted life years (QALYs), and both were discounted 3% annually. Probabilistic sensitivity analysis (PSA) considered parameter uncertainty.The statistical analysis estimated that first-line cryoablation generates a 47% reduction (p<0.001) in the rate of AF recurrence, a 73% reduction in the rate of subsequent ablation (p<0.001), and a 4.3% (p=0.025) increase in health-related quality of life (HRQoL), compared with first-line AADs. The PSA indicates that an individual treated with first-line cryoablation accrues less costs (-$3,862) and more QALYs (0.19) compared with first-line AADs. Cryoablation is cost saving in 98.4% of PSA iterations and has a 99.9% probability of being cost-effective at a cost-effectiveness threshold of $50,000 per QALY gained. Cost-effectiveness results were robust to changes in key model parameters.First-line cryoballoon ablation is cost-effective when compared with AADs for patients with symptomatic PAF.
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