AFib ablation makes financial sense, especially among heart failure patients
Catheter ablation is an "economically attractive" treatment option for atrial fibrillation (AFib) when compared to antiarrhythmic drug therapy alone,, according to a new study in Circulation.[1]
While the lifetime cost of catheter ablation for AFib averages $15,516 more than for drug therapy, it resulted in an additional 11.0 quality-adjusted life-years (QALYs) as opposed to 10.7 QALYs for drug therapy.
Those numbers—which work out to the equivalent of $57,893 per QALY gained—mean that catheter ablation treatments fall within the authors’ $100,000-per-QALY benchmark for considering a treatment to be economically attractive. The $100,000 figure is in line with numbers from the Institute for Clinical and Economic Review’s health-benefit price benchmarks, which currently values one QALY between $100,000 to $150,000.
“Catheter ablation of AFib has been shown to produce a sustained reduction in AFib recurrences and a durable improvement in QOL relative to standard drug therapy,” wrote Derek S. Chew, Ph.D., of the University of Calgary, and coauthors.
The economic attractiveness ruling is based solely on QALYs; the projected increase in actual life expectancy for patients who underwent catheter ablation compared to drug therapy is .08, which, at a cost of $183,318 per life-year, was not deemed significant enough to meet conventional criteria for economic attractiveness.
Additional value for heart failure patients
The authors also looked at data for a prespecified subgroup of 778 patients who recorded heart failure on their baseline report form, finding even larger increases in both life-years and QALYs for those who received catheter ablation.
For these patients, the additional cost for ablation versus drug therapy was $35,259, and the incremental benefits were 0.65 QALYs and 0.53 life-years, amounting to a cost of $54,135 per QALY gained and $70,907 per life-year gained—in both instances, a benefit that the authors consider economically attractive.
Overall, the study adds important data to an ongoing debate in the medical community about which treatments make the most sense for AFib patients both with and without a history of heart failure.
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Catheter ablation a cost-effective option for HF patients with AFib
Reference:
Chew, DS; Li, Y; Cowper, PA. ‘Cost-Effectiveness of Catheter Ablation Versus Antiarrhythmic Drug Therapy in Atrial Fibrillation: The CABANA Randomized Trial.” Circulation, June 21, 2022. DOI: 10.1161/CIRCULATIONAHA.122.058575.