The cost-effectiveness of treatment of supraventricular arrhythmias related to an accessory atrioventricular pathway: comparison of catheter ablation, surgical division and medical treatment.
BACKGROUND
Treatment alternatives for patients with incapacitating supraventricular arrhythmias related to an accessory atrioventricular pathway include transcatheter radiofrequency (RF) ablation, surgical division and long-term antiarrhythmic therapy (medical).


OBJECTIVE
The aim of this study was to compare in terms of cost and efficacy, transcatheter, surgical and medical treatment of patients with incapacitating supraventricular arrhythmias resulting from an accessory pathway.


METHODS
The study population consisted of 52 patients who underwent transcatheter RF ablation (20 consecutive patients), surgical treatment (20) and medical treatment (12). Two types of economic analysis were used. In all groups, a resource based costing method was used and in the medical and surgical treatment groups, a diagnostic related group (DRG) based costing method was used.


RESULTS
Eighteen out of 20 (90%) patients who underwent catheter ablation remained asymptomatic during 8.4 +/- 1.6 months of follow-up. All surgically treated patients remained asymptomatic during 54 +/- 15 months of follow-up. Only one of the 12 patients in the medical treatment group remained completely free of symptoms during the mean 58 +/- 23 month follow-up period. The mean cost (1992 Australian dollars) per patient, calculated on the basis of actual resources used (with a DRG based costing given in brackets), was $2746 +/- $800 for catheter ablation, $12141 +/- $4465 ($12880 +/- $3998) for surgical treatment and $1713 +/- $748 ($1967 +/- $33) for medical treatment. The total cost of management over 20 years is estimated to be: $2911 for catheter ablation, $17467 for surgery and $4959 for medical treatment.


CONCLUSIONS
In the long term transcatheter RF ablation is the most cost-effective treatment strategy for patients with incapacitating supraventricular arrhythmias related to an accessory pathway.
Weerasooriya
H R
HR
University of Western Australia.
Murdock
C J
CJ
Harris
A H
AH
Davis
M J
MJ
D000293:Adolescent; D000328:Adult; D001283:Atrioventricular Node / Q000002:abnormalities / Q000601:surgery*; D017115:Catheter Ablation / Q000191:economics*; D002648:Child; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups / Q000191:economics*; D004594:Electrophysiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015895:Relative Value Scales; D012189:Retrospective Studies; D013617:Tachycardia, Supraventricular / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D016896:Treatment Outcome