Cost-effectiveness of radiofrequency catheter ablation for the treatment of atrial fibrillation in the United Kingdom


McKenna, C; Palmer, S; Rodgers, M; Chambers, D; Hawkins, N; Golder, S; van Hout, S; Pepper, C; Todd, D; Woolacott, N; (2009) Cost-effectiveness of radiofrequency catheter ablation for the treatment of atrial fibrillation in the United Kingdom. Heart (British Cardiac Society), 95. pp. 542-549. ISSN 1355-6037 DOI: https://doi.org/10.1136/hrt.2008.147165

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Abstract

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. DESIGN: 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. MAIN OUTCOME MEASURE: 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.

Item Type: Article
Keywords: Anti-Arrhythmia Agents, economics, therapeutic use, Atrial Fibrillation, economics, therapy, Bayes Theorem, Catheter Ablation, economics, Cost-Benefit Analysis, Drug Costs, Great Britain, Humans, Quality-Adjusted Life Years, Stroke, economics, prevention & control, Treatment Outcome
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 19095714
Web of Science ID: 264195900007
URI: http://researchonline.lshtm.ac.uk/id/eprint/2534564

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