Cost-effectiveness of radiofrequency ablation for supraventricular tachycardia.
BACKGROUND
Radiofrequency ablation is an established but expensive treatment option for many forms of supraventricular tachycardia. Most cases of supraventricular tachycardia are not life-threatening; the goal of therapy is therefore to improve the patient's quality of life.


OBJECTIVE
To compare the cost-effectiveness of radiofrequency ablation with that of medical management of supraventricular tachycardia.


METHODS
Markov model.


METHODS
Costs were estimated from a major academic hospital and the literature, and treatment efficacy was estimated from reports from clinical studies at major medical centers. Probabilities of clinical outcomes were estimated from the literature. To account for the effect of radiofrequency ablation on quality of life, assessments by patients who had undergone the procedure were used.


METHODS
Cohort of symptomatic patients who experienced 4.6 unscheduled visits per year to an emergency department or a physician's office while receiving long-term drug therapy for supraventricular tachycardia.


METHODS
Patient lifetime.


CONCLUSIONS
Societal.


METHODS
Initial radiofrequency ablation, long-term antiarrhythmic drug therapy, and treatment of acute episodes of arrhythmia with antiarrhythmic drugs.


METHODS
Costs, quality-adjusted life-years, life-years, and marginal cost-effectiveness ratios.


RESULTS
Among patients who have monthly episodes of supraventricular tachycardia, radiofrequency ablation was the most effective and least expensive therapy and therefore dominated the drug therapy options. Radiofrequency ablation improved quality-adjusted life expectancy by 3.10 quality-adjusted life-years and reduced lifetime medical expenditures by $27 900 compared with long-term drug therapy. Long-term drug therapy was more effective and had lower costs than episodic drug therapy.


RESULTS
The findings were highly robust over substantial variations in assumptions about the efficacy and complication rate of radiofrequency ablation, including analyses in which the complication rate was tripled and efficacy was decreased substantially.


CONCLUSIONS
Radiofrequency ablation substantially improves quality of life and reduces costs when it is used to treat highly symptomatic patients. Although the benefit of radiofrequency ablation has not been studied in less symptomatic patients, a small improvement in quality of life is sufficient to give preference to radiofrequency ablation over drug therapy.
Cheng
C H
CH
Stanford Medical Informatics, 251 Campus Drive, MSOB X-215, Stanford University, Stanford, CA 94305-5479, USA.
Sanders
G D
GD
Hlatky
M A
MA
Heidenreich
P
P
McDonald
K M
KM
Lee
B K
BK
Larson
M S
MS
Owens
D K
DK
D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000191:economics / Q000627:therapeutic use; D017115:Catheter Ablation / Q000009:adverse effects / Q000191:economics*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004180:Direct Service Costs; D016527:Drug Costs; D006327:Heart Block / Q000209:etiology; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D013617:Tachycardia, Supraventricular / Q000188:drug therapy / Q000601:surgery*
D000889:Anti-Arrhythmia Agents