[Cost-benefit analysis of concomitant atrial fibrillation management in Spain].
OBJECTIVE
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice; this disorder is a risk factor for stroke and is associated with substantial morbidity and mortality. Our objective was to develop a cost-utility analysis of the different treatment alternatives in patients aged 40 years old or more with concomitant AF with valve disease in Spain, from the National Health System perspective.


METHODS
An economic evaluation through a Markov model with four health states (sinus rhythm, AF, dependent stroke, death) was developed to simulate the evolution of a cohort of 1,000 patients receiving each treatment alternative in addition to mitral valve surgery (drug therapy, surgical ablation and catheter ablation). The time horizon was 5 years, with a cycle length of 3 months. Data on costs and effects were obtained from the published literature and expert opinion and were discounted at 3.5%. A sensitivity analysis was developed to determine the robustness of the results.


RESULTS
The quality-adjusted life years (QALY) gained were 3.29, 3.89, and 3.83, respectively, for the alternatives of no ablation, surgical ablation and catheter ablation. The costs per patient were 5,770euro, 10,034euro and 11,289euro, respectively. The surgical ablation cost/QALY rate compared with no ablation was 7,145euro. Surgical ablation was dominant versus catheter ablation. The probabilistic sensitivity analysis showed that the results were robust.


CONCLUSIONS
Surgical ablation is a cost-effective treatment option in patients with concomitant AF, with a cost-effectiveness ratio under the efficiency threshold commonly accepted in Spain.
López Gude
María Jesús
MJ
Servicio de Cirugía Cardiaca, Hospital 12 de Octubre, Madrid, España.
Rodríguez Bezos
Desiré
D
Rodríguez Barrios
José Manuel
JM
D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000191:economics* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000191:economics* / Q000379:methods; D017115:Catheter Ablation / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D006350:Heart Valve Prosthesis / Q000191:economics; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000191:economics / Q000601:surgery; D008962:Models, Theoretical; D009010:Monte Carlo Method; D009313:National Health Programs / Q000191:economics; D019057:Quality-Adjusted Life Years; D013030:Spain / Q000453:epidemiology
D000889:Anti-Arrhythmia Agents