Abstract 6240: Cost Effectiveness of Radiofrequency Catheter Ablation vs. Anti-Arrhythmic Drugs for Paroxysmal Atrial Fibrillation
Background. Radiofrequency catheter ablation (RFA) is a rapidly growing management strategy for patients with AF. The potential cost-effectiveness of RFA for AF, relative to antiarrhythmic drug (AAD) therapy, has not been fully explored from the U.S. perspective.
Methods. We constructed a Markov disease simulation model for a hypothetical cohort of 60 year old men with paroxysmal AF refractory to at least one AAD, managed either with RFA (with repeat ablation and supplemental AAD treatment as needed) or AAD. Costs and quality-adjusted life years (QALYs) were projected over a 5 year time horizon. Model inputs were drawn from published clinical trial and registry data, from new registry and trial data analysis, and from data prospectively collected from AF patients managed with RFA at our institution. Key assumptions included: single procedure efficacy with RFA =60%, ablation cost =$15,000, and AF recurrence on first-line AAD =75%. Future costs and benefits were discounted at 3% per year.
Results. In the base case scenario, cumulative costs with the RFA and AAD strategies were $26,006 and $19,898, respectively. Over 5 years, the RFA cohort lived 3.52 QALYs, versus 3.38 for the AAD group. The incremental cost-effectiveness ratio for RFA vs. AAD was thus $43,890/QALY. Model results were most sensitive to the relative utility weights of successful ablation vs. unsuccessful drug therapy, and to the cost of an ablation procedure (Figure⇓).
Conclusions. Based on presently available data, RFA for highly symptomatic paroxysmal AF patients refractory to 1 or more AADs appears to be reasonably cost-effective compared with AAD therapy from the perspective of the US health care system.