Cost Effectiveness of Ventricular Tachycardia Ablation Versus Escalation of Antiarrhythmic Drug Therapy

Coyle, Kathryn; Coyle, Doug; Nault, Isabelle; Parkash, Ratika; Healey, Jeffrey S.; Gray, Christopher; Gardner, Martin J.; Sterns, Laurence D.; Essebag, Vidal; Hruczkowski, Tomasz; Blier, Louis; Wells, George; Tang, Antony; Stevenson, William G.; Sapp, John L.

doi:10.1016/j.jacep.2018.01.007

Cited by 29 publications

(31 citation statements)

References 11 publications

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“…This is not a surprising finding given that a reduction in VT burden with CA decreases both hospitalizations and emergency department attendances by 25% and 15%, respectively . In a recent substudy of the Ventricular Tachycardia Ablation Versus Escalation of Antiarrhythmic Drug Therapy in Ischemic heart Disease (VANISH) RCT, CA resulted in greater quality‐adjusted life‐years at a lower financial cost compared to amiodarone‐escalated group. Similar to the excess cost burden of repeat CAs for AF, this saving was predominantly due to the cost of required future ablation procedures and associated costs antiarrhythmic side effects, particularly amiodarone.…”

Section: Discussionmentioning

confidence: 92%

Section: Health Care Benefitmentioning

confidence: 99%

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Ten‐year trends in catheter ablation for ventricular tachycardia vs other interventional procedures in Australia

Anderson

Lee

Prabhu

et al. 2019

Cardiovasc electrophysiol

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Aims Major technological and procedural advancements have reinvigorated catheter ablation as adjunctive therapy for drug‐refractory ventricular tachycardia (VT). We examined temporal trends in VT ablations as compared to other interventional cardiovascular procedures namely, percutaneous coronary intervention (PCI) and atrial fibrillation (AF) ablation in Australia. Methods and Results A retrospective review of procedural numbers for VT ablations, AF ablations, and PCI was performed from 2008/09‐2016/17 the Australian Institute of Health, Welfare and Aging (AIHW), and Medicare Australia (MA) databases. Linear regression models were fitted to compare the trends in population‐adjusted procedural numbers over the 10‐year period. Data from the AIHW and MA sources respectively showed that (a) PCI had a 1.3% (AIHW data P = .15) and 1.8% (MA data P < .001) population‐adjusted increment per year, (b) AF ablations had a 12.7% (P < .001) and 11.7% (P < .001) per year population‐adjusted increment, and (c) VT ablations showed an 18% (P < .001) and 12.7% (P < .001) per year population‐adjusted increment. Growth of PCI was increasing at a lower rate than AF ablations (P < .001 for both AIHW and MA sources). Growth of VT ablation was significantly higher than AF ablations and PCI (AIHW: 18% vs 12.7% [P = .004] and 1.3% per year [P < .001]). Conclusion Catheter‐based VT ablation has increased significantly in Australia over the last decade, consistent with worldwide trends, and now surpassing all ablation procedures, including AF ablation and PCI for CAD. This data highlight the provision of additional resources to match the increasing demand for VT ablation procedures in Australia.

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Section: Discussionmentioning

confidence: 92%

Section: Health Care Benefitmentioning

confidence: 99%

Ten‐year trends in catheter ablation for ventricular tachycardia vs other interventional procedures in Australia

Anderson

Lee

Prabhu

et al. 2019

Cardiovasc electrophysiol

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“…These patients are frailer with a high burden of comorbidities as noted above. Although VT ablation is a complicated procedure with high associated expenses, it could be cost‐effective in the long run compared to an escalation of drug therapy as noted in VANISH trial 29 …”

Section: Discussionmentioning

confidence: 99%

Short‐term outcomes associated with inpatient ventricular tachycardia catheter ablation

Sharma

Tripathi

Naraparaju

et al. 2020

Pacing Clinical Electrophis

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Background: Utilization of catheter ablation of ventricular tachycardia (VT) has steadily increased in recent years. Exploring short-term outcomes is vital in health care planning and resource allocation.Methods: The Nationwide Readmissions Database from 2010 to 2014 was queried using the ICD-9 codes for VT (427.1) and catheter ablation (37.34) to identify study population. Incidence, causes of 30-day readmission, in-hospital complications as well as predictors of 30-day readmissions, complications, and cost of care were analyzed. Results:Among 11 725 patients who survived to discharge after index admission for VT ablation, 1911 (16.3%) were readmitted within 30 days. Paroxysmal VT was the most common cause of 30-day readmission (39.51%). Dyslipidemia, chronic kidney disease (CKD), previous CABG, congestive heart failure (CHF), chronic pulmonary disease, and anemia predicted increased risk of 30-day readmissions. The overall in-hospital complication rate was 8.2% with vascular and cardiac complications being the most common. Co-existing CKD and CHF and the need for mechanical circulatory support (MCS) predicted higher complication rates. Similarly increasing age, CKD, CHF, anemia, in-hospital use of MCS or left heart catheterization, teaching hospital, and disposition to nursing facilities predicted higher cost. Conclusion:Approximately one in six patients was readmitted after VT ablation, with paroxysmal VT being the most common cause of the readmission. A complication rate of 8.2% was noted.We also identified a predictive model for increased risk of readmission, complication, and factors influencing the cost of care that can be utilized to improve the outcomes related to VT ablation. K E Y W O R D S catheter ablation, NRD database, readmission, ventricular tachycardia 1 INTRODUCTION Sudden cardiac death (SCD) accounts for approximately 15% of total mortality in the United States and other industrialized countries. 1 Ventricular tachyarrhythmias are the dominant underlying rhythm leading to SCD. Treatment of different forms of VT is defined based on duration, morphology, and symptomatology. The management of VT has evolved considerably in recent times. Radiofrequency catheter ablation (RFA) is now frequently done to treat VT that results in implantable cardioverter defibrillator (ICD) shocks despite antiarrhythmic drugs, as an initial therapy alternative to medications and in those patients who are either not candidates for or refuse ICD 444 c ○ 2020 Wiley Periodicals, Inc. Pacing Clin Electrophysiol. 2020;43:444-455. wileyonlinelibrary.com/journal/pace

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“…A recent substudy of the Ventricular Tachycardia Ablation or Escalated Antiarrhytmic Drugs in Ischemic Heart Disease (VANISH) trial evaluated the cost effectiveness of catheter ablation compared with escalation of antiarrhythmic drug therapy in drug-resistant patients with ischemic cardiomyopathy and VT over 3 years. 7 Overall, ablation led to greater QALYs than antiarrhythmic drug therapy and higher cost ($65,126 vs $60,269; difference: $4857), mainly related to the upfront cost of ablation. This was offset by the costs of subsequent ablations and adverse outcomes in the medical therapy group.…”

mentioning

confidence: 95%

Health Economic Analysis of Catheter Ablation for Ventricular Tachycardia: Breaking Even With Medical Therapy?

Nery

Sadek

Nair

2019

Canadian Journal of Cardiology

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Cost Effectiveness of Ventricular Tachycardia Ablation Versus Escalation of Antiarrhythmic Drug Therapy

Abstract: For the total trial population, results are suggestive that ablation is cost effective compared with escalation of drug therapy. This result was only manifest for the subgroup of patients whose qualifying arrhythmia occurred despite amiodarone.

Cited by 29 publications

References 11 publications

Ten‐year trends in catheter ablation for ventricular tachycardia vs other interventional procedures in Australia

Ten‐year trends in catheter ablation for ventricular tachycardia vs other interventional procedures in Australia

Short‐term outcomes associated with inpatient ventricular tachycardia catheter ablation

Health Economic Analysis of Catheter Ablation for Ventricular Tachycardia: Breaking Even With Medical Therapy?

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