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12.06.2018 | Original Article | Ausgabe 8/2018

Pediatric Cardiology 8/2018

A Cost-Effective Analysis of Systematically Using Mapping Systems During Catheter Ablation Procedures in Children and Teenagers

Zeitschrift:
Pediatric Cardiology > Ausgabe 8/2018
Autoren:
Massimiliano Marini, Daniele Ravanelli, Fabrizio Guarracini, Maurizio Del Greco, Silvia Quintarelli, Anna Cima, Alessio Coser, Marta Martin, Aldo Valentini, Roberto Bonmassari
Wichtige Hinweise
The systematic use of a non-fluoroscopic mapping systems in an adult EP Lab allows us to reduce radiation exposure in children and young adults undergoing electrophysiological procedures. However the cost-effectiveness of this method remains unknown. In this work two different cost-effectiveness analyses are presented, applied and assessed.

Abstract

The aim of this study is to evaluate the cost-effectiveness of an extended use of 3D non-fluoroscopic mapping systems (NMSs) during paediatric catheter ablation (CA) in an adult EP Lab. This study includes 58 consecutive patients (aged between 8 and 18) who underwent CA from March 2005 to February 2015. We compare the fluoroscopy data of two groups: group I, patients who underwent CA from 2005 to 2008 using only fluoroscopy, and group II, patients who underwent CA from 2008 to 2015 performed also using NMSs. Two cost-effectiveness analyses were carried out: the first method was based on the alpha value (AV), and the second one was based on the value of a statistical life (VSL). For both methods, a children’s correction factor was also considered. The reduction cost estimated from all these methods was compared to the real additional cost of using NMSs. The use of an NMS during a CA procedure has led to an effective dose reduction (ΔE) of 2.8 milli-Sievert. All presented methods are based on parameters with a wide range of values. The use of an NMS, applying directly AV values or VSL values, is not cost-effective for most countries. Only considering the children’s correction factor, the CA procedure using an NMS seems to be cost-effective. The cost-effectiveness of a systematic use of NMSs during CA procedures in children and teenagers remains a challenging task. A positive result depends on which value of AV or VSL is considered and if the children’s correction factor is applied or not.

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