Cost‐Utility of Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure: An Economic Evaluation

Abstract

Background Recent trials comparing catheter ablation to medical therapy in patients with heart failure (HF) with symptomatic atrial fibrillation despite first‐line management have demonstrated a reduction in adverse outcomes. We performed an economic evaluation to estimate the cost‐utility of catheter ablation as second line therapy in patients with HF with reduced ejection fraction. Methods and Results A Markov model with health states of alive, dead, and alive with amiodarone toxicity was constructed, using the perspective of the Canadian healthcare payer. Patients in the alive states were at risk of HF and non‐HF hospitalizations. Parameters were obtained from randomized trials and Alberta health system data for costs and outcomes. A lifetime time horizon was adopted, with discounting at 3.0% annually. Probabilistic and 1‐way sensitivity analyses were performed. Costs are reported in 2018 Canadian dollars. A patient treated with catheter ablation experienced lifetime costs of $64 960 and 5.63 quality‐adjusted life‐years (QALY), compared with $49 865 and 5.18 QALYs for medical treatment. The incremental cost‐effectiveness ratio was $35 360/QALY (95% CI, $21 518–77 419), with a 90% chance of being cost‐effective at a willingness‐to‐pay threshold of $50 000/QALY. A minimum mortality reduction of 28%, or a minimum duration of benefit of >1 to 2 years was required for catheter ablation to be attractive at this threshold. Conclusions Catheter ablation is likely to be cost‐effective as a second line intervention for patients with HF with symptomatic atrial fibrillation, with incremental cost‐effectiveness ratio $35 360/QALY, as long as over half of the relative mortality benefit observed in extant trials is borne out in future studies.

Cost-Effectiveness of Catheter Ablation Versus Antiarrhythmic Drug Therapy in Atrial Fibrillation: The CABANA Randomized Clinical Trial

“…The estimate of cost-effectiveness in the CABANA HF subgroup is consistent with published model-based economic evaluations of AF ablation in the HF population. 41,42,45 These previous economic analyses evaluated a population consisting of patients with HF with reduced ejection fraction. In the present study, CABANA patients with HF primarily had preserved ejection fraction and <8% had an left ventricular ejection fraction <35% when echocardiographic data were available.…”

Cost-effectiveness of rhythm control strategy: Ablation versus antiarrhythmic drugs for treating atrial fibrillation in Korea based on real-world data

“…Despite advances in ablation and procedure techniques, costeffectiveness analyses of ablation-based rhythm control therapy have yielded heterogeneous conclusion that depend on the analysis model, parameters derived from the literature, and study population (17,18,(35)(36)(37)(38)(39). Recently, Chew et al (18) reported randomized trialbased economic evaluation results suggesting that catheter ablation of AF is economically attractive compared with drug therapy with an ICER of $57,893/QALY using the conventional WTP threshold of $100,000/QALY in the US.…”

Feasibility and safety of interventional electrophysiology and catheter ablation in the South African public sector: Challenges and opportunities for comprehensive cardiac electrophysiology in South Africa

“…However, numerous studies have shown that catheter ablation for atrial is cost-effective compared to antiarrhythmic drugs, particularly over a five-year horizon or longer, particularly in symptomatic patients and heart failure patients. 19 The perceived costs of catheter ablation are upfront procedure-related costs which are balanced out by the improved patient quality of life and reduced arrhythmia recurrences and hospitalisations. 20 The current study demonstrates that offering comprehensive and safe cardiac electrophysiology services in the South African public sector is highly feasible.…”