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Background Currently, there are no drugs that have been proven to be effective against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Because of its broad antiviral activity, interferon (IFN) should be evaluated as a potential therapeutic agent for treatment of coronavirus disease 2019 (COVID-19), especially while COVID-19-specific therapies are still under development. Methods Confirmed COVID-19 patients hospitalized in the First Affiliated Hospital, School of Medicine, Zhejiang University in Hangzhou, China, from January 19 to February 19, 2020 were enrolled in a retrospective study. The patients were separated into an IFN group and a control group according to whether they received initial IFN-α2b inhalation treatment after admission. Propensity-score matching was used to balance the confounding factors. Results A total of 104 confirmed COVID-19 patients, 68 in the IFN group and 36 in the control group, were enrolled. Less hypertension (27.9% vs. 55.6%, P=0.006), dyspnea (8.8% vs. 25.0%, P=0.025), or diarrhea (4.4% vs. 19.4%, P=0.030) was observed in the IFN group. Lower levels of albumin and C-reactive protein and higher level of sodium were observed in the IFN group. Glucocorticoid dosage was lower in the IFN group (median, 40 vs. 80 mg/d, P=0.025). Compared to the control group, fewer patients in the IFN group were ventilated (13.2% vs. 33.3%, P=0.015) and admitted to intensive care unit (ICU) (16.2% vs. 44.4%, P=0.002). There were also fewer critical patients in the IFN group (7.4% vs. 25.0%, P=0.017) upon admission. Although complications during admission process were comparable between groups, the discharge rate (85.3% vs. 66.7%, P=0.027) was higher and the hospitalization time (16 vs. 21 d, P=0.015) was shorter in the IFN group. When other confounding factors were not considered, virus shedding time (10 vs. 13 d, P=0.014) was also shorter in the IFN group. However, when the influence of other factors was eliminated using propensity score matching, virus shedding time was not significantly shorter than that of the control group (12 vs. 15 d, P=0.206). Conclusions IFN-α2b spray inhalation did not shorten virus shedding time of SARS-CoV-2 in hospitalized patients.

During the prevention of coronavirus disease 2019 (COVID-19), epidemiological data is essential for controlling the source of infection, cutting off the route of transmission, and protecting vulnerable populations. Following Law of the People’s Republic of China on Prevention and Treatment of Infectious Diseases and other related regulations, medical institutions have been authorized to collect the detailed information of patients, while it is still a formidable task in megacities because of the significant patient mobility and the existing information sharing barrier. As a smart city which strengthens precise epidemic prevention and control, Shanghai has established a multi-department platform named “one-net management” on dynamic information monitoring. By sharing epidemiological data with medical institutions under a safe environment, we believe that the ability to prevent and control epidemics among medical institutions will be effectively and comprehensively improved.

9 p. BACKGROUND: A health technology assessment (HTA) of catheter ablation for atrial fibrillation (CA-AF) was commissioned by the Belgian government and performed by the Belgian Health Care Knowledge Centre (KCE). In this context, a systematic review of the economic literature was performed to assess the procedure's value for money. METHODS: A systematic search for economic literature about the cost-effectiveness of CA-AF was performed by consulting various databases: CRD (Centre for Reviews and Dissemination) HTA and CDSR (Cochrane Database of Systematic Reviews) Technology Assessment, websites of HTA institutes, NHS EED (NHS Economic Evaluation Database), Medline (OVID), EMBASE and EconLit. No time or language restrictions were imposed and pre-defined selection criteria were used. The two-step selection procedure was performed by two persons. References of the selected studies were checked for additional relevant citations. RESULTS: Out of 697 references, seven relevant studies were selected. Based on current evidence and economic considerations, the rationale to support catheter ablation as first-line treatment was lacking.The economic evaluations for second-line catheter ablation included several assumptions that make the results rather optimistic or subject to large uncertainty. First, overall AAD (antiarrhythmic drugs) use after ablation was higher in reality than assumed in the economic evaluations, which had its impact on costs and effects. Second, several models focused on the impact of ablation on preventing stroke. This was questionable because there was no direct hard evidence from RCTs to support this assumption. An indirect impact through stroke on mortality should also be regarded with caution. Furthermore, all models included an impact on quality of life (QoL)/utility and assumed a long-term impact. Unfortunately, none of the RCTs measured QoL with a generic utility instrument and information on the long-term impact on both mortality and QoL was lacking. CONCLUSIONS: Catheter ablation is associated with high initial costs and may lead to life-threatening complications. Its cost-effectiveness depends on the belief one places on the impact on utility and/or preventing stroke, and the duration of these effects. Having no hard evidence for these important variables is rather troublesome. Although the technique is widely spread, the scientific evidence is insufficient for drawing conclusions about the intervention's cost-effectiveness.

5 p. Catheter ablation is an increasingly used treatment for atrial fibrillation but Hans Van Brabandt, Mattias Neyt, and Carl Devos argue that enthusiasm for the procedure is not justified by the evidence on efficacy and cost effectiveness and its use should be strictly limited

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663-668 Aim To assess the outcome and cost of catheter ablation of atrial fibrillation (AF) in Belgium. Methods and results From a nationwide health insurers' database, we retrieved claims data of all patients that underwent a catheter ablation of AF from November 2007 through December 2008. Based on data on reimbursed procedures and drugs, we assessed AF recurrence using different models. Costs related to the index hospitalization were calculated. During the observation period, 830 patients underwent a first catheter ablation of AF. Two-year follow-up data were available for all patients, with an average follow-up of 30.2 months. Seventy-seven percent of patients were treated for paroxysmal AF. Recurrence of AF was defined as the occurrence of one of the following events: a repeat catheter ablation, an electric cardioversion or an antiarrhythmic drug (AAD) prescription, the latter two taking into account a blanking period of 3 months. Atrial fibrillation recurred in 59.8% of patients after 1 year and in 65.9% of them after 2 years. If AAD prescription was considered as an indicator for ablation failure only if it occurred after a 1 month AAD-free period, recurrence of AF occurred in 37.3% of patients after 1 year and in 49.9% after 2 years. Based on the prescription of rate and rhythm control drugs before the ablation, we conclude that up to 15.8% of patients underwent catheter ablation as first-line therapy. Catheter ablation of AF in Belgium on average costs about €9600 for the initial intervention. Conclusion Since the effectiveness of catheter ablation of AF appears to be less favourable in real-world practice as compared with results reported in clinical trials, and given the high initial cost of the procedure, we suggest to strictly limiting the intervention to patients in whom it is currently believed to be most beneficial, i.e. those with severely symptomatic and drug-refractory paroxysmal AF with no or minimal structural heart disease.

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17 p. Ill. La fibrillation auriculaire (FA) est un trouble du rythme cardiaque qui provoque parfois des palpitations incommodantes ainsi que de la fatigue. Des médicaments peuvent atténuer ces symptômes, mais sont sans effet chez certains patients. Pour ces derniers, l’ablation par cathéter pourrait être une solution. Le Centre Fédéral d’Expertise des Soins de Santé (KCE) a examiné cette intervention de plus près. Le nombre de traitements de la FA par ablation par cathéter a doublé ces dernières années en Belgique. Cependant, il s’agit d’une intervention complexe qui n’est pas sans risques, et la moitié des patients semble avoir rechuté dans les 2 ans. Le cout de l’intervention, près de €10.000, est complètement remboursé au patient par l’INAMI. Le KCE plaide pour une restriction du remboursement aux type de patients pour lesquels les études ont montré que l’intervention leur est la plus profitable, et pour une information préalable au patient des avantages et inconvénients. En outre, l’intervention devrait être effectuée uniquement par des médecins expérimentés dans des centres expérimentés. 1. OBJECTIFS 3 -- 2. INTRODUCTION 3 -- 2.1. FIBRILLATION AURICULAIRE 3 -- 2.2. ABLATION DE LA FIBRILLATION AURICULAIRE 4 -- 3. ABLATION PAR CATHÉTER DE LA FIBRILLATION AURICULAIRE: DESCRIPTION DE LA TECHNIQUE 4 -- 4. EFFICACITÉ DE L'ABLATION PAR CATHÉTER DE LA FIBRILLATION AURICULAIRE 5 -- 4.1. PROCÉDURE DE RECHERCHE DOCUMENTAIRE 5 -- 4.2. EFFICACITÉ CLINIQUE DE L'ABLATION PAR CATHÉTER DE LA FA 5 -- 4.3. RÉSULTATS D'ETUDES CLINIQUES NON ENCORE PUBLIÉES 7 -- 5. SECURITÉ DE L’ABLATION PAR CATHÉTER DE LA FIBRILLATION AURICULAIRE 8 -- 6. ABLATION PAR CATHÉTER DE LA FIBRILLATION AURICULAIRE EN BELGIQUE 9 -- 6.1. INTRODUCTION 9 -- 6.2. DONNÉES POUR LA BELGIQUE 10 -- 6.3. ÉVALUATION DE L'EFFICACITÉ CLINIQUE DE L'ABLATION DE LA FA EN BELGIQUE 10 -- 7. ÉVALUATION ÉCONOMIQUE DE L'ABLATION PAR CATHÉTER 13 -- 8. QUESTIONS ORGANISATIONNELLES 14 -- 9. CONCLUSION 14

16 p. Ill. Voorkamerfibrillatie (VKF) is een hartritmestoornis die soms hinderlijke hartkloppingen en vermoeidheid veroorzaakt. Geneesmiddelen kunnen deze klachten onder controle houden, maar werken niet bij alle patiënten. Katheter-ablatie zou voor hen een oplossing kunnen bieden. Het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) bekeek deze ingreep van naderbij. Het aantal katheter-ablaties voor VKF is de laatste jaren verdubbeld in België. Het is nochtans een complexe ingreep die niet risicoloos is, en de helft van de patiënten blijkt na 2 jaar te hervallen. De kostprijs, bijna €10.000, wordt voor de patiënt volledig door het RIZIV terugbetaald. Het KCE pleit ervoor om de terugbetaling te beperken tot die patiënten waarvan studies aantonen dat ze er het meest mee gebaat zijn, en om deze patiënten vooraf goed te informeren over de voor- en nadelen. Daarnaast zou de ingreep slechts mogen uitgevoerd worden door ervaren artsen in ervaren centra 1. DOELSTELLINGEN 3 -- 2. INLEIDING 3 -- 2.1. VOORKAMERFIBRILLATIE 3 -- 2.2. ABLATIE VAN VOORKAMERFIBRILLATIE 4 -- 3. KATHETER-ABLATIE VAN VOORKAMERFIBRILLATIE: BESCHRIJVING VAN DE TECHNIEK 4 -- 4. EFFECTIVITEIT VAN KATHETER-ABLATIE VAN VOORKAMERFIBRILLATIE 5 -- 4.1. ONDERZOEK VAN DE LITERATUUR 5 -- 4.2. KLINISCHE EFFECTIVITEIT VAN KATHETER-ABLATIE VAN VKF 5 -- 4.3. RESULTATEN VAN NOG NIET GEPUBLICEERDE KLINISCHE STUDIES 6 -- 5. VEILIGHEID VAN KATHETER-ABLATIE VAN VOORKAMERFIBRILLATIE 7 -- 6. KATHETER-ABLATIE VAN VOORKAMERFIBRILLATIE IN BELGIË 8 -- 6.1. INLEIDING 8 -- 6.2. BELGISCHE GEGEVENS 8 -- 6.3. EVALUATIE VAN DE KLINISCHE EFFECTIVITEIT VAN VKF-ABLATIE IN BELGIË 9 -- 7. ECONOMISCHE EVALUATIE VAN KATHETER-ABLATIE 12 -- 8. ORGANISATORISCHE ASPECTEN 12 -- 9. BESLUIT 13

VI, 125 p. Ill. Voorkamerfibrillatie (VKF) is een hartritmestoornis die soms hinderlijke hartkloppingen en vermoeidheid veroorzaakt. Geneesmiddelen kunnen deze klachten onder controle houden, maar werken niet bij alle patiënten. Katheter-ablatie zou voor hen een oplossing kunnen bieden. Het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) bekeek deze ingreep van naderbij. Het aantal katheter-ablaties voor VKF is de laatste jaren verdubbeld in België. Het is nochtans een complexe ingreep die niet risicoloos is, en de helft van de patiënten blijkt na 2 jaar te hervallen. De kostprijs, bijna €10.000, wordt voor de patiënt volledig door het RIZIV terugbetaald. Het KCE pleit ervoor om de terugbetaling te beperken tot die patiënten waarvan studies aantonen dat ze er het meest mee gebaat zijn, en om deze patiënten vooraf goed te informeren over de voor- en nadelen. Daarnaast zou de ingreep slechts mogen uitgevoerd worden door ervaren artsen in ervaren centra SYNTHESE 11 -- 1. DOELSTELLINGEN 11 -- 2. INLEIDING 11 -- 2.1. VOORKAMERFIBRILLATIE 11 -- 2.2. ABLATIE VAN VOORKAMERFIBRILLATIE 12 -- 3. KATHETER-ABLATIE VAN VOORKAMERFIBRILLATIE: BESCHRIJVING VAN DE TECHNIEK 13 -- 4. EFFECTIVITEIT VAN KATHETER-ABLATIE VAN VOORKAMERFIBRILLATIE 14 -- 4.1. ONDERZOEK VAN DE LITERATUUR 14 -- 4.2. KLINISCHE EFFECTIVITEIT VAN KATHETER-ABLATIE VAN VKF 14 -- 4.3. RESULTATEN VAN NOG NIET GEPUBLICEERDE KLINISCHE STUDIES 15 -- 5. VEILIGHEID VAN KATHETER-ABLATIE VAN VOORKAMERFIBRILLATIE 16 -- 6. KATHETER-ABLATIE VAN VOORKAMERFIBRILLATIE IN BELGIË 17 -- 6.1. INLEIDING... 17 -- 6.2. BELGISCHE GEGEVENS 18 -- 6.3. EVALUATIE VAN DE KLINISCHE EFFECTIVITEIT VAN VKF-ABLATIE IN BELGIË 18 -- 7. ECONOMISCHE EVALUATIE VAN KATHETER-ABLATIE 21 -- 8. ORGANISATORISCHE ASPECTEN 22 -- 9. BESLUIT 22 -- SCIENTIFIC REPORT 24 -- 1. SCOPE 24 -- 2. CLINICAL BACKGROUND 24 -- 2.1. NORMAL HEART RHYTHM 24 -- 2.2. ATRIAL FIBRILLATION 25 -- 2.3. TREATMENT 26 -- 2.3.1. Rhythm control 26 -- 2.3.2. Rate control 27 -- 2.3.3. Prevention of thrombo-embolic complications 27 -- 2.3.4. The rate vs. rhythm control enigma 27 -- 3. CATHETER ABLATION: TECHNOLOGY DESCRIPTION 28 -- 4. CLINICAL EFFECTIVENESS OF CA-AF 29 -- 4.1. LITERATURE SEARCH 29 -- 4.1.1. Search strategy 29 -- 4.1.2. Studies selected from the systematic literature search 29 -- 4.1.3. Unpublished and ongoing RCTs 31 -- 4.2. CLINICAL EFFECTIVENESS OF RADIOFREQUENCY ABLATION OF ATRIAL FIBRILLATION 31 -- 4.2.1. Conclusions of previous systematic reviews and HTA reports 31 -- 4.2.2. Data obtained from published randomised trials 32 -- 4.2.3. Unpublished RCTs investigating radiofrequency catheter ablation 34 -- 4.2.4. Short-term data from observational studies 36 -- 4.2.5. Long term effectiveness data 36 -- 4.3. CLINICAL EFFECTIVENESS OF CA-AF WITH ENERGY SOURCES OTHER THAN -- RADIOFREQUENCY 38 -- 4.3.1. Cryo-ablation 38 -- 4.3.2. Laser balloon ablation 38 -- 4.3.3. Ultrasound balloon ablation 38 -- 4.4. DISCUSSION AND SUMMARY OF THE IMPACT OF CA ON RHYTHM CONTROL 39 -- 4.5. IMPACT OF CATHETER ABLATION ON QUALITY OF LIFE 40 -- 4.5.1. Literature search 40 -- 4.5.2. Overview quality-of-life measures 41 -- 4.5.3. Discussion 45 -- 4.5.4. Conclusion 46 -- 5. SAFETY OF CA-AF 46 -- 5.1. PROCEDURAL RISKS 46 -- 5.2. X-RAY BURDEN 48 -- 6. BELGIAN PRACTICE 49 -- 6.1. INTRODUCTION 49 -- 6.2. DATA SOURCES AND METHODOLOGY 52 -- 6.2.1. IMA-AIM data 52 -- 6.2.2. Other data 53 -- 6.3. POPULATION DESCRIPTION... 54 -- 6.4. RESULTS 54 -- 6.4.1. Number of CA-AF per patient 54 -- 6.4.2. Patients’ risk profile 55 -- 6.4.3. Antiarrhythmic drugs 55 -- 6.4.4. Rate control drugs 57 -- 6.4.5. Drug use before the index CA-AF 57 -- 6.4.6. Electric cardioversions 58 -- 6.4.7. Redo catheter ablation of atrial fibrillation 59 -- 6.4.8. Estimate of the effectiveness of the index CA-AF 60 -- 6.5. COSTS DESCRIPTION 63 -- 6.6. CONCLUSION 66 -- 7. COST-EFFECTIVENESS OF CA-AF 66 -- 7.1. LITERATURE SEARCH 66 -- 7.1.1. Search strategy 66 -- 7.1.2. Selection criteria 66 -- 7.2. OVERVIEW OF ECONOMIC EVALUATIONS 69 -- 7.3. DISCUSSION 81 -- 7.3.1. Before/after cost analyses 81 -- 7.3.2. Rate control 81 -- 7.3.3. Procedural complications 81 -- 7.3.4. Use of drugs 82 -- 7.3.5. Stroke and mortality 82 -- 7.3.6. Quality of life 82 -- 7.3.7. Time horizon 83 -- 7.4. CONCLUSION 83 -- 8. PATIENT ISSUES 84 -- 9. REGULATORY AND ORGANISATIONAL ISSUES 85 -- 9.1. BELGIAN LEGISLATION 85 -- 9.2. BELGIAN CATHETER ABLATION REGISTRATION 86 -- 9.3. EUROPEAN AND US REGULATION 86 -- 9.4. VOLUME OUTCOME RELATIONSHIP 87 -- 10. DISCUSSION 88 -- APPENDIX 90 -- 1. LITERATURE SEARCH (CLINICAL EFFECTIVENESS) 90 -- 1.1. HTA REPORTS 90 -- 1.1.1. CRD database 90 -- 1.1.2. Individual HTA agencies from INAHTA database 91 -- 1.1.3. EUnetHTA POP (planned and ongoing) database 91 -- 1.2. SYSTEMATIC REVIEWS 91 -- 1.2.1. CRD database 91 -- 1.2.2. Cochrane Database of Systematic Reviews 91 -- 1.2.3. PubMed 91 -- 1.2.4. EMBASE 91 -- 1.3. RANDOMISED CONTROLLED TRIALS 92 -- 1.3.1. PubMed 92 -- 1.3.2. EMBASE 92 -- 2. QUALITY APPRAISAL OF HEALTH TECHNOLOGY ASSESSMENT REPORTS 92 -- 2.1. CANADIAN AGENCY FOR DRUGS AND TECHNOLOGIES IN HEALTH (CADTH, SEP 2010).28 93 -- 2.2. INSTITUTE FOR CLINICAL AND ECONOMIC REVIEW (ICER, SEP 2010).20 95 -- 3. QUALITY APPRAISAL OF SYSTEMATIC REVIEWS 97 -- 3.1. PARKASH ET AL.31 97 -- 3.2. BONANNO ET AL.30 98 -- 4. LITERATURE SEARCH (QUALITY OF LIFE) 99 -- 5. NOMENCLATURE CODES 101 -- 6. COSTS DESCRIPTION 104 -- 7. LITERATURE SEARCH (COST-EFFECTIVENESS) 105 -- 8. DATA EXTRACTION SHEET 117 -- REFERENCES 119