Cost-effectiveness of radiofrequency catheter ablation for atrial fibrillation.
OBJECTIVE
We sought to compare the cost-effectiveness of left atrial catheter ablation (LACA), amiodarone, and rate control therapy in the management of atrial fibrillation (AF).


BACKGROUND
Left atrial catheter ablation has been performed to eliminate AF, but its cost-effectiveness is unknown.


METHODS
We developed a decision-analytic model to evaluate the cost-effectiveness of LACA in 55- and 65-year-old cohorts with AF at moderate and low stroke risk. Costs, health utilities, and transition probabilities were derived from published literature and Medicare data. We performed primary threshold analyses to determine the minimum level of LACA efficacy and stroke risk reduction needed to make LACA cost-effective at 50,000 dollars and 100,000 dollars per quality-adjusted life-year (QALY) thresholds.


RESULTS
In 65-year-old subjects with AF at moderate stroke risk, relative reduction in stroke risk with an 80% LACA efficacy rate for sinus rhythm restoration would need to be > or =42% and > or =11% to yield incremental cost-effectiveness ratios (ICERs) <50,000 dollars and 100,000 dollars per QALY, respectively. Higher and lower LACA efficacy rates would require correspondingly lower and higher stroke risk reduction for equivalent ICER thresholds. In the 55-year-old moderate stroke risk cohort, lower LACA efficacy rates or stroke risk reduction would be needed for the same ICER thresholds. In patients at low stroke risk, LACA was unlikely to be cost-effective.


CONCLUSIONS
The use of LACA may be cost-effective in patients with AF at moderate risk for stroke, but it is not cost-effective in low-risk patients. Our threshold analyses may provide a framework for the design of future clinical trials by providing effect size estimates for LACA efficacy needed.
Chan
Paul S
PS
Division of Cardiology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA. paulchan@umich.edu
Vijan
Sandeep
S
Morady
Fred
F
Oral
Hakan
H
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000191:economics* / Q000601:surgery*; D017115:Catheter Ablation / Q000191:economics*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control