title: Radiofrequency ablation versus cryoablation for atrioventricular nodal re-entrant tachycardia in children: a value comparison.
abstract: BACKGROUND
  It is unclear whether cryoablation or radiofrequency ablation offers better value for treating atrioventricular nodal re-entrant tachycardia in children. We aimed to compare the value of these procedures for treating atrioventricular nodal re-entrant tachycardia in children, with value being outcomes relative to costs.
  
  
  METHODS
  We performed a retrospective cohort study of all atrioventricular nodal re-entrant tachycardia ablations for children (age⩽18 years) from July, 2009 to June, 2011 at our institution. Costs included fixed costs, miscellaneous hospital costs, and labour costs, and key outcomes were acute and long-term success (6 months) of the ablations. We conducted T-tests and regression analyses to investigate the associations between the ablation procedure type and the cost and success of the ablations.
  
  
  RESULTS
  Of 96 unique cases performed by three paediatric electrophysiologists, 48 were cryoablation only, 42 radiofrequency ablation only, and six were a combination. Acute success was 100% for the cryoablation only and radiofrequency ablation only cases and 83% for the combination cases. There were no notable adverse events. The average total cost was $9636 for cryoablation cases, $9708 for radiofrequency ablation cases, and $10,967 for combination cases (p=0.51 for cryoablation only versus radiofrequency ablation only). The long-term success rate was 79.1% for cryoablation only, 92.8% for radiofrequency ablation only, and 66.7% for the combination (p=0.01 for cryoablation only versus radiofrequency ablation only), but long-term success varied notably by provider.
  
  
  CONCLUSIONS
  Cryoablation and radiofrequency ablation offer similar value in the short term for the treatment of atrioventricular nodal re-entrant tachycardia in children. Differences in long-term success may vary substantially by physician, and thus may lead to differences in long-term value.
authors.affiliation: 1Children's Healthcare of Atlanta,Emory University Rollins School of Public Health,Atlanta, GA,United States of America.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Oster
authors.affiliation: 3Department of Health Policy and Management,Emory University Rollins School of Public Health,Atlanta, GA,United States of America.
authors.forename: Zhou
authors.initials: Z
authors.lastname: Yang
authors.affiliation: 1Children's Healthcare of Atlanta,Emory University Rollins School of Public Health,Atlanta, GA,United States of America.
authors.forename: Kay
authors.initials: K
authors.lastname: Stewart-Huey
authors.affiliation: 1Children's Healthcare of Atlanta,Emory University Rollins School of Public Health,Atlanta, GA,United States of America.
authors.forename: Michelle
authors.initials: M
authors.lastname: Glanville
authors.affiliation: 1Children's Healthcare of Atlanta,Emory University Rollins School of Public Health,Atlanta, GA,United States of America.
authors.forename: Arlene
authors.initials: A
authors.lastname: Porter
authors.affiliation: 1Children's Healthcare of Atlanta,Emory University Rollins School of Public Health,Atlanta, GA,United States of America.
authors.forename: Robert
authors.initials: R
authors.lastname: Campbell
authors.affiliation: 1Children's Healthcare of Atlanta,Emory University Rollins School of Public Health,Atlanta, GA,United States of America.
authors.forename: Brad
authors.initials: B
authors.lastname: Webb
authors.affiliation: 1Children's Healthcare of Atlanta,Emory University Rollins School of Public Health,Atlanta, GA,United States of America.
authors.forename: Margaret
authors.initials: M
authors.lastname: Strieper
mesh_terms: D000293:Adolescent; D017115:Catheter Ablation / Q000191:economics / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003452:Cryosurgery / Q000191:economics / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000191:economics / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cryoablation; atrioventricular nodal re-entrant tachycardia; comparative effectiveness; radiofrequency ablation; value