Cost-effectiveness of radiofrequency catheter ablation for the treatment of atrial fibrillation in the United Kingdom.
OBJECTIVE
To assess the cost-effectiveness of radiofrequency catheter ablation (RFCA) compared with anti-arrhythmic drug (AAD) therapy for the treatment of atrial fibrillation (AF) from the perspective of the UK NHS.


METHODS
Bayesian evidence synthesis and decision analytical model.


METHODS
A systematic review and meta-analysis was conducted and Bayesian statistical methods used to synthesise the effectiveness evidence from randomised control trials. A decision analytical model was developed to assess the costs and consequences associated with the primary outcome of the trials over a lifetime time horizon.


METHODS
Costs from a health service perspective and outcomes measured as quality-adjusted life years (QALYs).


RESULTS
The incremental cost-effectiveness ratio of RFCA varied between pound7763 and pound7910 for each additional QALY according to baseline risk of stroke, with a probability of being cost-effective from 0.98 to 0.99 for a cost-effectiveness threshold of pound20 000. Results were sensitive to the duration of quality of life benefits from treatment.


CONCLUSIONS
RFCA is potentially cost-effective for the treatment of paroxysmal AF in patients' predominantly refractory to AAD therapy provided the quality-of-life benefits from treatment are maintained for more than 5 years. These findings remain subject to limitations in the existing evidence regarding the nature of life benefits and the prognostic importance of restoring normal sinus rhythm conferred using RFCA.
McKenna
C
C
Centre for Health Economics, University of York, Heslington, UK. cm535@york.ac.uk
Palmer
S
S
Rodgers
M
M
Chambers
D
D
Hawkins
N
N
Golder
S
S
Van Hout
S
S
Pepper
C
C
Todd
D
D
Woolacott
N
N
D000889:Anti-Arrhythmia Agents / Q000191:economics / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000191:economics / Q000628:therapy*; D001499:Bayes Theorem; D017115:Catheter Ablation / Q000191:economics*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006801:Humans; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000191:economics / Q000517:prevention & control; D016896:Treatment Outcome; D006113:United Kingdom
D000889:Anti-Arrhythmia Agents