Cost-effectiveness analysis of radiofrequency ablation in patients with atrial fibrillation

Authors: Matrenin K.I., Dombrovsky V.S.

Company: Center for Healthcare Quality Assessment and Control, Moscow, Russian Federation

For correspondence:  Sign in or register.

Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187- 2024-18-4-402-414

For citation: Matrenin K.I., Dombrovsky V.S. Cost-effectiveness analysis of radiofrequency ablation in patients with atrial fibrillation. Creative Cardiology. 2024; 18 (4): 402–414 (in Russ.). DOI: 10.24022/1997-3187-2024-18-4-402-414

Received / Accepted:  15.07.2024 / 17.09.2024

Keywords: clinical and economic analysis clinical and economic study atrial fibrillation radiofrequency ablation antiarrhythmic drugs

Download
Full text:  

 

Abstract

Purpose: To analyze the clinical and economic effectiveness of radiofrequency ablation (RFA) in patients with atrial fibrillation (AF) compared with antiarrhythmic drug (AAD) therapy.

Materials and Methods. We evaluated the comparative clinical and economic effectiveness of 2 therapeutic interventions, radiofrequency ablation (RFA) versus antiarrhythmic drugs (AAD), in patients with atrial fibrillation (AF) in 2 patient populations, a realistic (2,571,931 patients) and a hypothetical (1,000 patients). The number of hospitalizations for cardiovascular events (CVEs) and all-cause deaths were predicted from meta-analyses found in a systematic search. Direct medical costs of RFA and AAD use and indirect costs due to loss of gross domestic product (GDP), number of deaths and hospitalizations, number of deaths and hospitalizations averted, cost per death and hospitalization averted, and economic impact per 1 ruble invested were calculated.

Results. Fewer deaths and greater costs were expected among patients with AF treated with RFA+AAD than with AAD alone. The cost of 1 averted death ranged from 13.92 to 2.78 million rubles, the economic effect per 1 additional invested ruble for 1 year, 3 years and 8 years was 0.048, 0.227 and 1.065 rubles, respectively.

Conclusion. The use of RFA in a population of patients with AF, can lead to a reduction in the number of hospitalizations for CVEs and deaths, requiring additional costs, which will be partially offset by a reduction in direct medical costs and indirect costs associated with GDP losses. The economic impact per 1 ruble invested for RFA reaches and exceeds 1 ruble by the 8th year of modeling.

References

  1. Clinical recommendations “Atrial fibrillation and flutter in adults”. All-Russian public organization “Russian Cardiological Society”; All-Russian Scientific Society of Specialists in Clinical Electrophysiology, Arrhythmology and Electrical Stimulation; Association of Cardiovascular Surgeons of Russia. Moscow; 2020 (in Russ.).
  2. Popovich L.D. Analysis of the potential socio-economic damage caused to society in connection with the development of atrial fibrillation in the population of different age groups in the Russian Federation. National Research University Higher School of Economics. Moscow; 2023 (in Russ.).
  3. Golukhova E.Z. Report on the Work of the Chief Freelance Cardiologist-Arrhythmologist of the Ministry of Health of Russia for the Year 2020, Academician of the Russian Academy of Sciences. Moscow; 2020 (in Russ.). https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/056/600/original/Отчет_за_2020_год_Голухова.pdf?1624888958 (accessed December 16, 2024).
  4. The State Register of Medicines https://grls.minzdrav.gov.ru/grls.aspx (accessed June 18, 2023).
  5. Zheng Z.H., Fan J., Ji C.C., Cheng Y.J., Chen X.M., Jiang J.Z., Wu S.H. Long-term outcomes and improvements in quality of life in patients with atrial fibrillation treated with catheter ablation vs. antiarrhythmic drugs. Am. J. Cardiovasc. Drugs. 2021; 21: 299–320. DOI: 10.1007/s40256-020-00435-9
  6. The State register of marginal selling prices https://grls.minzdrav.gov.ru/pricelims.aspx (accessed June 18, 2023).
  7. Rosstat presents the second estimate of GDP for 2023. https://rosstat.gov.ru/folder/313/document/234206 (accessed June 18, 2023).
  8. Population of the Russian Federation by gender and age. https://rosstat.gov.ru/compendium/document/13284 (дата accessed June 18, 2023).
  9. Forecast of the socio-economic development of the Russian Federation for 2024 and the planned period of 2025 and 2026. https://www.economy.gov.ru/material/directions/makroec/prognozy_socialno_ekonomicheskogo_razvitiya/prognoz_socialno_ekonomicheskogo_razvitiya_rf_na_2024_god_i_na_planovyy_period_2025_i_2026_godov.html (accessed June 18, 2023).
  10. Change in population of the Russian Federation size according to forecast options 1 https://rosstat.gov.ru/storage/mediabank/Progn_1.xls (accessed June 18, 2023).

About Authors

  • Kirill I. Matrenin, Chief Specialist; ORCID
  • Vladislav S. Dombrovskiy, Chief Specialist; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery