A cost-consequence analysis comparing three cardiac ablation strategies for the treatment of paroxysmal atrial fibrillation.

IF 2.9 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Journal of Medical Economics Pub Date : 2024-01-01 Epub Date: 2024-07-01 DOI:10.1080/13696998.2024.2369433
Mileen van de Kar, Lukas Dekker, Ines Timmermanns, Domenico Della Rocca, Gian-Battista Chierchia, Lise Da Riis-Vestergaard, Steffen Uffenorde, John Morgan, Julian Chun
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Abstract

Background and aims: Cardiac ablation is a well-established method for treating atrial fibrillation (AF). Pulsed field ablation (PFA) is a non-thermal therapeutic alternative to radiofrequency ablation (RFA) and cryoballoon ablation (CRYO). PFA uses high-voltage electric pulses to target cells. The present analysis aims to quantify the costs, outcomes, and resources associated with these three ablation strategies for paroxysmal AF.

Methods: Real-world clinical data were prospectively collected during index hospitalization by three European medical centers (Belgium, Germany, the Netherlands) specialized in cardiac ablation. These data included procedure times (pre-procedural, skin-to-skin and post-procedural), resource use, and staff burden. Data regarding complications associated with each of the three treatment options and redo procedures were extracted from the literature. Costs were collected from hospital economic formularies and published cost databases. A cost-consequence model from the hospital perspective was built to estimate the impact of the three treatment options in terms of effectiveness and costs.

Results: Across the three centers, N = 91 patients were included over a period of 12 months. A significant difference was seen in pre-procedural time (mean ± SD, PFA: 13.6 ± 3.7 min, CRYO: 18.8 ± 6.6 min, RFA: 20.4 ± 6.4 min; p < .001). Procedural time (skin-to-skin) was also different across alternatives (PFA: 50.9 ± 22.4 min, CRYO: 74.5 ± 24.5 min, RFA: 140.2 ± 82.4 min; p < .0001). The model reported an overall cost of €216,535 per 100 patients treated with PFA, €301,510 per 100 patients treated with CRYO and €346,594 per 100 patients treated with RFA. Overall, the cumulative savings associated with PFA (excluding kit costs) were €850 and €1,301 per patient compared to CRYO and RFA, respectively.

Conclusion: PFA demonstrated shorter procedure time compared to CRYO and RFA. Model estimates indicate that these time savings result in cost savings for hospitals and reduce outlay on redo procedures. Clinical practice in individual hospitals varies and may impact the ability to transfer the results of this analysis to other settings.

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对治疗阵发性心房颤动的三种心脏消融策略进行成本-后果分析比较。
背景和目的心脏消融术是治疗心房颤动(房颤)的一种行之有效的方法。脉冲场消融术(PFA)是射频消融术(RFA)和冷冻球囊消融术(CRYO)的非热疗替代方法。PFA 使用高压电脉冲来靶向细胞。本分析旨在量化与这三种阵发性房颤消融策略相关的成本、疗效和资源。方法欧洲三家心脏消融专科医疗中心(比利时、德国和荷兰)在患者住院期间前瞻性地收集了真实世界的临床数据。这些数据包括手术时间(术前、术中和术后)、资源使用和工作人员负担。与三种治疗方案和重做手术相关的并发症数据来自文献。成本数据来自医院经济手册和已公布的成本数据库。从医院的角度建立了一个成本-后果模型,以估算三种治疗方案在效果和成本方面的影响。手术前时间有明显差异(平均值±标度,PFA:13.6±3.7 分钟,CRYO:18.8±6.6 分钟,RFA:20.4±6.4 分钟;p
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来源期刊
Journal of Medical Economics
Journal of Medical Economics HEALTH CARE SCIENCES & SERVICES-MEDICINE, GENERAL & INTERNAL
CiteScore
4.50
自引率
4.20%
发文量
122
期刊介绍: Journal of Medical Economics'' mission is to provide ethical, unbiased and rapid publication of quality content that is validated by rigorous peer review. The aim of Journal of Medical Economics is to serve the information needs of the pharmacoeconomics and healthcare research community, to help translate research advances into patient care and be a leader in transparency/disclosure by facilitating a collaborative and honest approach to publication. Journal of Medical Economics publishes high-quality economic assessments of novel therapeutic and device interventions for an international audience
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