This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Calkins, H. Articles by Strauss, M. J. Search for Related Content PubMed PubMed Citation Articles by Calkins, H. Articles by Strauss, M. J. Related Collections Health policy and outcome research Electrophysiology Ablation/ICD/surgery Arrhythmias, clinical electrophysiology, drugs

(Circulation. 2000;101:280.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Cost-Effectiveness of Catheter Ablation in Patients With Ventricular Tachycardia

Hugh Calkins, MD; J. Thomas Bigger, Jr, MD; Stacey J. Ackerman, MSE, PhD; Steven B. Duff, MS; David Wilber, MD; Robert A. Kerr, BA; Miriam Bar-Din, MPH; Kathleen M. Beusterien, MPH; Michael J. Strauss, MD, MPH

From Johns Hopkins University, Baltimore, Md (H.C.); Columbia University (J.T.B.), New York, NY; Covance Health Economics and Outcomes Services Inc (S.J.A., S.B.D., R.A.K., M.B.-D., K.B., M.J.S.), Washington, DC; and University of Chicago (D.W.), Ill.

Correspondence to Hugh Calkins, MD, Division of Cardiovascular Medicine, Johns Hopkins Hospital, 600 North Wolfe Street, Carnegie Building, Room 592, Baltimore, MD 21287. E-mail hcalkins{at}welchlink.welch.jhu.edu

Background—This study evaluated the cost-effectiveness of catheter ablation therapy versus amiodarone for treating ventricular tachycardia (VT) in patients with structural heart disease. The analysis used a societal perspective for a hypothetical cohort of VT patients with implantable cardioverter-defibrillators, who were experiencing frequent shocks.

Methods and Results—We calculated incremental cost-effectiveness of ablation relative to amiodarone over 5 years after treatment initiation. Event probabilities were from the Chilli randomized clinical trial (Chilli Cooled Ablation System, Cardiac Pathways Corporation, Sunnyvale, Calif), the literature, and a consensus panel. Costs were from 1998 national Medicare reimbursement schedules. Quality-of-life weights (utilities) were estimated using an established preference measurement technique. In a hypothetical cohort of 10 000 patients, 5-year costs were higher for patients undergoing ablation compared with amiodarone therapy ($21 795 versus $19 075). Ablation also produced a greater increase in quality of life (2.78 versus 2.65 quality-adjusted life-years [QALYs]). This yielded a cost-effectiveness ratio of $20 923 per QALY gained for ablation compared with amiodarone. Results were relatively insensitive to assumptions about ablation success and durability. In less severe patients with good ejection fractions who suffer their first VT episode, the incremental cost-effectiveness ratio was $6028 per QALY gained. These cost-effectiveness ratios are within the range generally thought to warrant technology adoption.

Conclusions—This study demonstrates that, from a societal perspective, catheter ablation appears to be a cost-effective alternative to amiodarone for treating VT patients.

Key Words: catheter ablation • tachycardia • cost-benefit analysis • tachyarrhythmias

This article has been cited by other articles:

				A. M. Feldman, G. de Lissovoy, M. R. Bristow, L. A. Saxon, T. De Marco, D. A. Kass, J. Boehmer, S. Singh, D. J. Whellan, P. Carson, et al. Cost Effectiveness of Cardiac Resynchronization Therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Trial J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2311 - 2321. [Abstract] [Full Text] [PDF]