title: The cost-effectiveness of radiofrequency catheter ablation as first-line treatment for paroxysmal atrial fibrillation: results from a MANTRA-PAF substudy.
abstract: OBJECTIVE
  The aim of this prospective substudy was to estimate the cost-effectiveness of treating paroxysmal atrial fibrillation (AF) with radiofrequency catheter ablation (RFA) compared with antiarrhythmic drugs (AADs) as first-line treatment.
  
  
  RESULTS
  A decision-analytic Markov model, based on MANTRA-PAF (Medical Antiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation) study data, was developed to study long-term effects and costs of RFA compared with AADs as first-line treatment. Positive clinical effects were found in the overall population, a gain of an average 0.06 quality-adjusted life years (QALYs) to an incremental cost of €3033, resulting in an incremental cost-effectiveness ratio of €50 570/QALY. However, the result of the subgroup analyses showed that RFA was less costly and more effective in younger patients. This implied an incremental cost-effectiveness ratio of €3434/QALY in ≤50-year-old patients respectively €108 937/QALY in >50-year-old patients.
  
  
  CONCLUSIONS
  Radiofrequency catheter ablation as first-line treatment is a cost-effective strategy for younger patients with paroxysmal AF. However, the cost-effectiveness of using RFA as first-line therapy in older patients is uncertain, and in most of these AADs should be attempted before RFA (MANTRA-PAF ClinicalTrials.gov number; NCT00133211).
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden mattias.aronsson@liu.se.
authors.forename: Mattias
authors.initials: M
authors.lastname: Aronsson
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Walfridsson
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Janzon
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Department of Medical and Health Sciences, Division of Nursing Science, Linkoping University, Linkoping, Sweden.
authors.forename: Ulla
authors.initials: U
authors.lastname: Walfridsson
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Jens Cosedis
authors.initials: JC
authors.lastname: Nielsen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Peter Steen
authors.initials: PS
authors.lastname: Hansen
authors.affiliation: Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Arne
authors.initials: A
authors.lastname: Johannessen
authors.affiliation: Heart Center Co., Tampere University Hospital, Tampere, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Raatikainen
authors.affiliation: Leipzig University Hospital, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.affiliation: Lund University Hospital, Lund, Sweden.
authors.forename: Ole
authors.initials: O
authors.lastname: Kongstad
authors.affiliation: Rigshospitalet, Copenhagen, Denmark.
authors.forename: Steen
authors.initials: S
authors.lastname: Pehrson
authors.affiliation: University Hospital, Örebro, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Englund
authors.affiliation: Heart Center, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Hartikainen
authors.affiliation: Danish Information Technology Centre for Education and Research, Aarhus, Denmark.
authors.forename: Leif Spange
authors.initials: LS
authors.lastname: Mortensen
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Lars-Åke
authors.initials: LÅ
authors.lastname: Levin
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000191:economics* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D017115:Catheter Ablation / Q000191:economics* / Q000401:mortality; D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Anti-arrhythmic drugs; Atrial fibrillation; Cost-effectiveness; Radiofrequency ablation