Cost comparison of ablation versus antiarrhythmic drugs as first-line therapy for atrial fibrillation: an economic evaluation of the RAAFT pilot study.
BACKGROUND
Radiofrequency ablation (RFA) has become an accepted therapy for atrial fibrillation (AF). The objective of this study was to perform an economic evaluation of RFA versus antiarrhythmic drug therapy (AAD) as first-line treatment of symptomatic paroxysmal AF.


METHODS
To estimate and compare the costs of RFA versus AAD, a decision analytic model was developed using data on AF recurrence, hospitalization rates, AAD use, and treatment crossover rates derived directly from the Randomized Trial of RFA versus AAD as First-Line Treatment of Symptomatic Atrial Fibrillation (RAAFT). Resource utilization was modeled to reflect Canadian clinical practice in AF management. Unit costs of healthcare interactions were based on available Canadian government resources and published literature. Costs were assessed based on intention-to-treat. Total expected costs were computed to include initial treatment, hospital stay, physician fees, diagnostic tests, and outpatient visits. Sensitivity analyses were performed to account for the uncertainties. The study was conducted from the third party payer's perspective and costs are reported in 2005 Canadian dollars with 3% discount rate used in the analysis.


RESULTS
During the 2-month blanking period following therapy selection, total average costs for RFA and AAD were $10,465 and $2,556, respectively; at 1-year follow-up, these were $12,823 and $6,053; and total 2-year cumulative total average costs were $15,303 and $14,392. Sensitivity analyses did not alter the results, suggesting the model is robust.


CONCLUSIONS
RFA as first-line treatment strategy in patients with symptomatic paroxysmal AF was cost neutral 2 years after the initial procedure compared to AAD.
Khaykin
Yaariv
Y
Division of Cardiology, Southlake Regional Health Center, Newmarket, Ontario, Canada. y.khaykin@utoronto.ca
Wang
Xiaoyin
X
Natale
Andrea
A
Wazni
Oussama M
OM
Skanes
Allan C
AC
Humphries
Karin H
KH
Kerr
Charles R
CR
Verma
Atul
A
Morillo
Carlos A
CA
D000889:Anti-Arrhythmia Agents / Q000191:economics* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D002170:Canada / Q000453:epidemiology; D017115:Catheter Ablation / Q000191:economics* / Q000706:statistics & numerical data*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D018803:Models, Economic; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents