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Cost-effectiveness of Catheter Ablation Treatment for Patients with Symptomatic Atrial Fibrillation

Background: Atrial Fibrillation is the most common cardiac arrhythmia. It increases the risk of thromboembolic events and many atrial fibrillation patients suffer quality of life impairment due to disturbed heart rhythm. Pulmonary vein isolation using radiofrequency catheter ablation treatment is aimed at maintaining sinus rhythm ultimately improving quality of life. Randomized clinical trial have shown that catheter ablation is more effective than antiarrhythmic drugs for the treatment of atrial fibrillation, but its impact on quality of life and cost-effectiveness has not been widely studied.
Aims: To assess the cost-effectiveness of radiofrequency ablation (RFA) vs. antiarrhythmic drug (AAD) treatment, among symptomatic atrial fibrillation patients not previously responding to AAD.
Methods: A decision-analytic Markov model was developed to assess costs and health outcomes in terms of quality adjusted life years (QALYs) of RFA and AAD over a lifetime time horizon. We conducted a literature search and used data from several sources as input variables of the model. One-year rates of atrial fibrillation with RFA and AAD, respectively, were available from published randomized clinical trials. Other data sources were published papers and register data.
Results: The RFA treatment strategy was associated with reduced costs and an incremental gain in QALYs compared to the AAD treatment strategy. The results were sensitive to whether long-term quality of life improvement is maintained for the RFA treatment strategy and the risk of stroke in the different atrial fibrillation health states.
Conclusion: This study shows that the short-term improvement in atrial fibrillation associated with RFA is likely to lead to long-term quality of life improvement and lower costs indicating that RFA is cost-effective compared to AAD.

Credits: Nathalie Eckard; Thomas Davidson; Håkan Walfridsson; Lars-Åke Levin

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