Evaluating the Cost-effectiveness of Catheter Ablation of Atrial Fibrillation

Abstract

Atrial fibrillation (AF) is one of the most common cardiac conditions treated in primary care and specialty cardiology settings, and is associated with considerable morbidity, mortality and cost. Catheter ablation, typically by electrically isolating the pulmonary veins and surrounding tissue, is more effective at maintaining sinus rhythm than conventional antiarrhythmic drug therapy and is now recommended as first-line therapy. From a value standpoint, the cost-effectiveness of ablation must incorporate the upfront procedural costs and risks with the benefits of longer term improvements in quality of life (QOL) and healthcare utilisation. Here, we present a primer on cost-effectiveness analysis (CEA), review the data on cost-effectiveness of AF ablation and outline key areas for further investigation.

Cost-effectiveness of ablation of ventricular tachycardia in ischaemic cardiomyopathy: limitations in the trial evidence base

“…We therefore elected only to model VT storm—this was taken to put the patient into the readmission health state of our model. Thus, rather than relying on significant use of expert opinion to infer utilities performed in previous studies,10 14 we included only health states with patient-reported utilities supported by verifiable objective data. This is an important distinction as the objectivity of expert opinion by interested parties is difficult to confirm.…”

“…To account for recurrent clinical events, a Markov model instead of a decision tree was employed to simulate a hypothetical cohort of 1000 patients undergoing a VT ablation strategy and 1000 patients undergoing an AAD strategy. Following previous modelling studies in catheter ablation,10 14 we considered a 5-year time horizon for the base-case analysis, striking a balance between clinical relevance and available evidence on long-term cost and outcomes in this population. Scenarios with both a 10-year and lifetime horizon were considered in sensitivity analyses.…”

Cost-Effectiveness of Cardiac Radiosurgery for Atrial Fibrillation: Implications for Reducing Health Care Morbidity, Utilization, and Costs

“…The reported costs of catheter ablation for AF have been observed to have significant variations, even within the same country [ 35 ]. While hospital billing records report that the cost of catheter ablation for AF is $17,173 in the U.S., government reports indicate that the cost of catheter ablation in the U.S. is $26,584 [ 15 , 35 ].…”

“…The reported costs of catheter ablation for AF have been observed to have significant variations, even within the same country [ 35 ]. While hospital billing records report that the cost of catheter ablation for AF is $17,173 in the U.S., government reports indicate that the cost of catheter ablation in the U.S. is $26,584 [ 15 , 35 ]. A recent study estimated that the cost for AF ablations that used CARTO/3D, non-CARTO/non-3D mapping, and NAVx systems had a range between $16,278 and $21,294; other studies reported costs of AF ablation ranging from $14,000 to $18,000 [ 28 , 29 ].…”

Cardiac MRI to Manage Atrial Fibrillation

“…AF is a common arrhythmia in clinical practice, with a prevalence of 2.7 million–6.1 million that is expected to rise to 5.6 million–12 million by 2050 in the US alone. [ 1 , 2 ] Patients with AF have an increased risk of stroke and mortality and a decreased quality of life. [ 3 ] In addition, management of AF increases the cost of healthcare.…”