PCV39 RADIOFREQUENCY CATHETER ABLATION WITH WARFARIN VERSUS ANTIARRHYTHMIC DRUGS WITH NEW ORAL ANTICOAGULANTS FOR THE TREATMENT OF PAROXYSMAL ATRIAL FIBRILLATION IN CHINA: A COST- EFFECTIVENESS ANALYSIS

Abstract

To evaluate the cost-effectiveness of radiofrequency catheter ablation (RFCA) using contact-force catheter (Thermocool SmartTouch®) + warfarin versus antiarrhythmic drugs (AAD) + new oral anticoagulants (NOAC) in paroxysmal atrial fibrillation (PAF) patients from third-party payer's perspective in China. A two-part model was developed to estimate the cost-effectiveness of these two treatments. The short-term part was a decision-tree (1 year) including surgery-related complications and drug toxicity. The long-term was a Markov chain (lifetime) including the health states of normal sinus rhythms, AF recurrence, heart failure, stroke, post stroke, intracranial hemorrhages (ICH), post ICH, myocardial Infarction (MI), post MI, gastrointestinal bleeding and dead. Clinical efficacy, utility and cost data were obtained from published literature. The model calculated quality-adjusted life-years (QALYs) and total costs per patient. One-way and probabilistic sensitivity analyses were conducted. Captured by lifetime Markov model plus 1-year decision tree model, the total costs per patient for RFCA vs. AAD groups were ¥107,497 vs. ¥149,764; QALYs 8.16 vs. 7.58. From the 7th year, RFCA + warfarin became cost-effective (the incremental cost-effectiveness ratios at 7th year was ¥98,579/QALY, lower than the recommended threshold, 3xGDP/capita in China, ¥178,980). Furthermore, RFCA became cost-saving from the 9th year till lifetime with better effectiveness and lower overall costs compared with AAD. Both one-way and probabilistic sensitivity analyses confirmed the robustness of the results. Compared with AAD + NOAC, RFCA using contact force catheter + warfarin is cost-saving in long term for the treatment of PAF in China.