心力衰竭药物治疗在房颤介导的心肌病康复患者中的成本效益分析：WITHDRAW-AF随机临床试验的分析。
完整摘要 · 中文译文
背景：WITHDRAW-AF试验表明，在精心挑选的消融后心房颤动介导性心肌病恢复的患者中，射血分数降低的心力衰竭（HFrEF）药物治疗可以安全撤除。在本研究中，我们考察了该策略的经济影响。 方法：我们在试验期间并通过5年马尔可夫模型比较了各策略的成本和结局。功能状态通过最大摄氧量（VO2max）和6分钟步行试验距离（6MWT）评估，生活质量通过映射至EQ-5D-5L的明尼苏达心力衰竭生活质量问卷（MLHFQ）评估。概率敏感性分析通过2000次蒙特卡洛模拟进行。 结果：试验期间药物成本节省为每例患者$1031（$1572 vs $2604，p < 0.001）。5年间，撤药与继续治疗的模型预测成本分别为$3901（95% CI：$3852-$3950）与$8446（95% CI：$8375-$8517）。结局有利于撤药；6MWT在61.8%的模拟中（差异29.39 m，95% CI：23.03-35.74），VO2max在68.1%中（差异4.02 ml/kg/min，95% CI：3.49-4.44），MLHFQ在53.7%中（差异1.71，95% CI：0.57-2.84）。质量调整生命年（QALYs）相当（差异0.003，95% CI：-0.05-0.01）。 结论：在恢复的心房颤动介导性心肌病中，撤除HFrEF药物治疗代表成本最小化，且不损害功能状态或生活质量。
完整摘要 · 英文原文
BACKGROUND: The WITHDRAW-AF trial demonstrated HFrEF pharmacotherapy can be safely withdrawn in carefully selected patients with recovered atrial fibrillation-mediated cardiomyopathy post-ablation. In this study, we examined the economic implications of this strategy. METHODS: We compared costs and outcomes of each strategy during the trial and through a 5-year Markov model. Functional status was assessed by VO2max and 6-min walk test distance (6MWT), and quality of life by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) mapped to the EQ-5D-5L. Probabilistic sensitivity analysis was through 2000 Monte Carlo simulations. RESULTS: In-trial medication cost savings were $1031/patient ($1572 vs $2604, p < 0.001). Over 5 years, projected modelled costs for withdrawal versus continuation were $3901 (95% CI: $3852-$3950) versus $8446 (95% CI: $8375-$8517). Outcomes favoured withdrawal; 6MWT in 61.8% of simulations (difference 29.39 m, 95% CI: 23.03-35.74), VO2max in 68.1% (difference 4.02 ml/kg/min, 95% CI: 3.49-4.44), and MLHFQ in 53.7% (difference 1.71, 95% CI: 0.57-2.84). QALYs were comparable (difference 0.003, 95% CI: -0.05-0.01). CONCLUSION: In recovered atrial fibrillation-mediated cardiomyopathy, HFrEF pharmacotherapy withdrawal represented cost-minimisation without detriment to functional status or quality of life.