title: Cost-Effectiveness of Radiofrequency Ablation for Supraventricular Tachycardia in Guatemala: Patient outcomes and economic analysis from a low-middle-income country.
abstract: BACKGROUND
  Radiofrequency ablation (RFA) is an established but expensive treatment alternative for many forms supraventricular tachycardia (SVT). Currently no studies exist on the cost-effectiveness of RFA compared to medical treatment (MT) in adult Latin American population.
  
  
  METHODS
  Between 2007 and 2012, we identified 103 adults who underwent RFA for SVT in the National Unit of Cardiovascular Surgery (UNICAR) in Guatemala. A decision tree was developed with all clinical outcome parameter estimates obtained from the Adult Electrophysiology Clinic. Costs were obtained from UNICAR's administration. A cost-effectiveness analysis was conducted which evaluated costs and quality adjusted life years (QALYs) to compare interventions in terms of their incremental cost-effectiveness ratios (ICERs).
  
  
  RESULTS
  The first RFA had 83% success and cumulative 94% success was achieved with a second one. The cost of the RFA procedure itself was $5,411. RFA gains 1.46 QALYs and saves $ 7,993 compared to of MT for patients with SVT. This demonstrates that in Guatemala, RFA dominates MT in the management of SVT. Using assumptions based largely on the outcomes in UNICAR, we found that the RFA is highly cost-effective. This is a consistent finding, even after varying assumptions about efficacy, complication rates and quality of life.
  
  
  CONCLUSIONS
  RFA dominates MT by improving quality of life and reducing expenditures when used to treat severely symptomatic patients with SVT in Guatemala. The robustness of these finding to variations in parameter assumptions, suggests these findings may hold in other similar settings.
authors.affiliation: National Unit of Cardiovascular Surgery, UNICAR. Guatemala, Guatemala ; Methodist Dallas Medical Center, Internal Medicine Department. Dallas TX, USA.
authors.forename: Benjamin Cruz
authors.initials: BC
authors.lastname: Rodriguez
authors.affiliation: National Unit of Cardiovascular Surgery, UNICAR. Guatemala, Guatemala.
authors.forename: Sergio
authors.initials: S
authors.lastname: Leal
authors.affiliation: National Unit of Cardiovascular Surgery, UNICAR. Guatemala, Guatemala.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Calvimontes
authors.affiliation: University of Michigan, Department of Health Management and Policy, School of Public Health. Ann Arbor, MI, USA.
authors.forename: David
authors.initials: D
authors.lastname: Hutton
keywords: Cost-effectiveness; cost-utility; radiofrequency ablation; supraventricular tachycardia