A cost-utility analysis for catheter ablation of atrial fibrillation in combination with warfarin and dabigatran based on the CHADS₂ score in Japan

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• 作者：Takehiro Kimura ; MD ; PhD ; FHRS^a ; ^{kimura@z7.keio.jp} ; Ataru Igarashi ; PhD^b ; Shunya Ikeda ; MD ; PhD^c ; Kazuaki Nakajima ; MD^a ; Shin Kashimura ; MD^a ; Akira Kunitomi ; MD^a ; Yoshinori Katsumata ; MD ; PhD^a ; Takahiko Nishiyama ; MD ; PhD^a ; Nobuhiro Nishiyama ; MD ; PhD^a ; Kotaro Fukumoto ; MD ; PhD ; FHRS^a ; Yoko Tanimoto ; MD ; PhD^a ; Yoshiyasu Aizawa ; MD ; PhD ; FHRS^a ; Keiichi Fukuda ; MD ; PhD^a ; Seiji Takatsuki ; MD ; PhD^a
• 关键词：Cost-utility analysis ; Atrial fibrillation ; Catheter ablation ; Warfarin ; Dabigatran
• 刊名：Journal of Cardiology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：69
• 期：1
• 页码：89-97
• 全文大小：739 K
• 卷排序：69

文摘

We aimed to clarify the cost-effectiveness of an expensive combination therapy for atrial fibrillation (AF) using both catheter ablation and dabigatran compared with warfarin at each CHADS2 score for patients in Japan.MethodsA Markov model was constructed to analyze costs and quality-adjusted life years associated with AF therapeutic options with a time horizon of 10 years. The target population was 60-year-old patients with paroxysmal AF. The indication for anticoagulation was determined according to the Japanese guideline. Anticoagulation-related data were derived from the RE-LY study and the AF recurrence rate was set at 2.7% per month during the first 12 months and at 0.40% per month afterwards. Stroke risk was determined according to AF recurrence, anticoagulation, and CHADS2 score. The risks for stroke recurrence and stroke death were also considered. Costs were calculated from the healthcare payer's perspective, and only direct medical costs were included.ResultsWarfarin was the most preferred option for patients with a CHADS2 score of 0 from a health economics aspect. Ablation under warfarin was preferred for a CHADS2 score of 1–3, while ablation under dabigatran was preferred for a CHADS2 score ≥4. The quality of life score for AF had the largest impact on the incremental cost-effectiveness ratios in the analysis between the anticoagulation arm and the anticoagulation + ablation arm for a CHADS2 score of 2. Within the range of the Japanese willingness-to-pay threshold (¥5,000,000), the ablation + warfarin arm became the best option with its probability of 81.7% for a CHADS2 score of 2; the dabigatran + ablation arm was the most preferred option with its probability of 56.1% for a CHADS2 score of 4.ConclusionsAblation under dabigatran therapy is an expensive therapeutic option, but it might benefit patients with a low quality of life and a high CHADS2 score.