Radiofrequency ablation using the ThermoCool SmartTouch Catheter guided by ablation index versus antiarrhythmic drugs in atrial fibrillation treatment in China: a cost-consequence analysis

Abstract

Aim: To evaluate the costs and consequences of two front-line atrial fibrillation (AF) treatments from Chinese healthcare system perspective: radiofrequency catheter ablation (RFCA) using ThermoCool SmartTouch Catheter guided by Ablation Index (STAI), in comparison to antiarrhythmic drugs (AADs). Patients & methods: We simulated clinical and economic consequences for AF patients initially receiving STAI or AADs using a short-term decision tree model leading to a 10-year long-term Markov model. The model projected both clinical consequences and costs associated with, among others, AF, heart failure (HF), strokes, and deaths due to AF or AF related complications. Data informing the models included combination of a local real-world study and published clinical studies. Results: STAI was advantageous versus AADs on all 4 main clinical outcomes evaluated; AF: 25.83% lower (12.84% vs 38.67%), HF: 2.22% lower (1.33% vs 3.55%), stroke or post stroke: 1.82% lower (10.00% vs 11.82%) and deaths due to AF or AF related complications: 0.64% lower (4.11% vs 4.75%). The average total cost per patient in STAI group was ¥16,682 lower (¥123,124 vs ¥139,806). The one-way sensitivity analysis indicated that the difference in total cost was most sensitive to annual AF recurrence probability in AADs-treated patients. Probabilistic sensitivity analysis indicated a 98.5% probability that RFCA treatment would result in cost savings by the end of the 10th year. Conclusion: Radiofrequency catheter ablation using SmartTouch catheter guided by Ablation Index was superior to AADs as the first-line AF treatment in Chinese setting with better clinical outcomes and at lower costs over a 10-year time horizon.

Keywords: ablation index; antiarrhythmic drugs; atrial fibrillation; cost-consequence analysis; real-world study.

Figure 1.. Diagrams of models.

(A) Short-term model. (B) Long-term model. AAD: Antiarrhythmic drug; AF: Atrial fibrillation; GIB: Gastrointestinal bleeding; HF: Heart failure; ICH: Intracranial hemorrhage; MI: Myocardial infarction; NSR: Normal sinus rhythm; RFCA: Radiofrequency catheter ablation; PICH: Post-intracranial hemorrhage; PMI: Post myocardial infarction; PST: Post stoke.

Figure 2.. First one-way sensitivity analysis – incremental cost (per patient) between STAI and antiarrhythmic drug groups.

Only variations with impact on the base case result are shown in the chart. *Each parameter varied across the range of their 95% confidence intervals (CIs); if the 95% CI of the parameter was not available, we assumed that the standard deviation was 10% of the base case values and then calculated the 95% CI based on their assumed distributions. AADs: Antiarrhythmic drugs; AF: Atrial fibrillation; HF: Heart failure; NOACs: New oral anticoagulants; STAI: ThermoCool SmartTouch Catheter guided by Ablation Index.

Figure 3.. Second one-way sensitivity analysis – incremental costs (per patient) between STAI and antiarrhythmic drug groups (varying time horizon).

Only variations with impact on the base case result are shown in the chart.

Figure 4.. Probabilistic sensitivity analysis – incremental cost (per patient) between STAI and antiarrhythmic drug groups.