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

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Paroxysmal or persistent atrial fibrillation (n=202). Intervention: Radiofrequency catheter ablation using ThermoCool SmartTouch Catheter guided by Ablation Index (STAI) vs. Antiarrhythmic drugs (AADs). Primary outcome: Atrial fibrillation prevalence at 10 years (ARR 25.83%).

Biqi Zhang; Jie Han; Dongchen Zhou; Jiajia Jiang; Yunlong Lu; Chenyu Zuo; Xingwei Lu; Jianwei Xuan; Aohan Zu; Yuxian He; Xingang Sun; Lu Chen; Liangrong Zheng

doi:10.57264/cer-2023-0035

February 1, 2024Open Access

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

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Key result

First-line AI-guided catheter ablation linked to ~26-point lower 10-year AF prevalence vs AADs.

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Why the study?

Does first-line radiofrequency catheter ablation guided by Ablation Index (STAI) improve long-term clinical outcomes and reduce healthcare costs compared with antiarrhythmic drug therapy in patients with atrial fibrillation in China?

Key Points

To evaluate the long-term clinical consequences and healthcare costs of first-line radiofrequency catheter ablation guided by Ablation Index compared to antiarrhythmic drugs in patients with atrial fibrillation from the Chinese healthcare system perspective.
Simulated clinical and economic outcomes using a short-term decision tree model followed by a 10-year Markov model comparing first-line ablation index–guided radiofrequency catheter ablation (STAI) to antiarrhythmic drugs (AADs).
Informed model parameters using a combination of local single-center real-world data and published literature, explicitly incorporating repeat ablations and treatment crossover.
Assessed incidence of atrial fibrillation, heart failure, stroke, and mortality alongside direct medical costs over a 10-year horizon using one-way and probabilistic sensitivity analyses.
Over 10 years, STAI reduced rates of atrial fibrillation by 25.83% (12.84% vs 38.67%), heart failure by 2.22% (1.33% vs 3.55%), stroke or post-stroke by 1.82% (10.00% vs 11.82%), and mortality due to atrial fibrillation or related complications by 0.64% (4.11% vs 4.75%).
Average total medical cost per patient in the STAI group was ¥16,682 lower than in the AADs group (¥123,124 vs ¥139,806), with drug therapy having a cost advantage up to 7 years that reversed in favor of ablation at 8 years or longer.
Probabilistic sensitivity analysis demonstrated a 98.5% probability that STAI treatment results in overall cost savings by the end of the 10th year.

Study Design

Type

Observational (n=202)

Multicenter

No

Structured PICO

Does first-line radiofrequency catheter ablation guided by Ablation Index (STAI) improve long-term clinical outcomes and reduce healthcare costs compared with antiarrhythmic drug therapy in patients with atrial fibrillation in China?

P

Population

202 newly diagnosed paroxysmal or persistent atrial fibrillation patients in China followed for 1 year in a prospective observational cohort informing a 10,000-patient, 10-year Markov simulation (starting age 60, 40% female).

E

Exposure

First-line radiofrequency catheter ablation (RFCA) using the contact-force catheter (ThermoCool SmartTouch) guided by Ablation Index (STAI) in combination with the Carto 3-dimensional electroanatomic mapping system, plus anticoagulant treatment (warfarin or novel oral anticoagulants).

C

Comparator

First-line antiarrhythmic drug (AAD) therapy managed at physician discretion, plus novel oral anticoagulants (rivaroxaban or dabigatran).

O

Outcome

Simulated 10-year clinical consequences (prevalence of AF recurrence, heart failure, stroke or post-stroke, and deaths due to AF or AF-related complications) and direct medical costs from the Chinese healthcare system perspective.hard clinical

Main Result

Absolute Risk Reduction: 25.83

Absolute Event Rate: 12.84% vs 38.67%

Absolute Risk Reduction: 25.83%

In the Chinese healthcare setting, first-line radiofrequency ablation using an Ablation Index-guided SmartTouch catheter is a dominant strategy over antiarrhythmic drugs, projecting superior clinical outcomes and lower total medical costs over a 10-year horizon.

Limitations

Real-world input data were based on a single-center study with a relatively small sample size (n=202), where no procedure-related complications, deaths, or severe AAD toxicity events were observed.
Results from a single tertiary center may not be representative of current practice and costs in other regions of China.
Incidence of arrhythmia recurrence may have been underestimated due to routine follow-up visits being impacted by the coronavirus epidemic.
Lack of real-world Chinese data on treatment crossover and repeat ablation probabilities required reliance on global studies validated by local experts.
Patient quality of life and health utility measures were not included as outcomes.
Real-world data informing the short-term model was based on a single-center study with a relatively small sample size (n=202), which may not be representative of other regions in China.
No procedure-related complications, deaths, or severe AAD-related drug toxicity events were observed in the 1-year real-world study due to the small sample size.
Incidence of arrhythmia recurrence may have been underestimated, particularly for sporadic episodes, because routine follow-up visits were impacted by the coronavirus epidemic.
Cost of emergency room or urgent care visits were not included in the model due to lack of data.
Cost outcomes were sensitive to the probability of treatment crossover, which varies considerably across countries.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May favor first-line ablation for long-term AF control and costs in China; extends models yet leaves open prospective validation.

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.

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Cite This Study

Zhang et al. (2024) conducted an observational in Paroxysmal or persistent atrial fibrillation (n=202). Radiofrequency catheter ablation using ThermoCool SmartTouch Catheter guided by Ablation Index (STAI) vs. Antiarrhythmic drugs (AADs) was evaluated on Atrial fibrillation prevalence at 10 years (ARR 25.83%). First-line Ablation Index-guided SmartTouch catheter ablation reduced 10-year atrial fibrillation prevalence by 25.83% and saved ¥16,682 per patient vs antiarrhythmic drugs.

synapsesocial.com/papers/6a8c52166353673e316384d3 https://doi.org/10.57264/cer-2023-0035

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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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