Economic Evaluation of Catheter Ablation of Atrial Fibrillation in Patients with Heart Failure With Reduced Ejection Fraction.
Journal Article (Journal Article)
BACKGROUND: Randomized clinical trials have demonstrated that catheter ablation for atrial fibrillation in patients with heart failure with reduced ejection fraction may improve survival and other cardiovascular outcomes. METHODS: We constructed a decision-analytic Markov model to estimate the costs and benefits of catheter ablation and medical management in patients with symptomatic heart failure with reduced ejection fraction (left ventricular ejection fraction ≤35%) and atrial fibrillation over a lifetime horizon. Evidence from the published literature informed the model inputs, including clinical effectiveness data from meta-analyses. Probabilistic and deterministic sensitivity analyses were performed. A 3% discount rate was applied to both future costs and benefits. The primary outcome was the incremental cost-effectiveness ratio assessed from the US health care sector perspective. RESULTS: Catheter ablation was associated with 6.47 (95% CI, 5.89-6.93) quality-adjusted life years (QALYs) and a total cost of $105 657 (95% CI, $55 311-$191 934; 2018 US dollars), compared with 5.30 (95% CI, 5.20-5.39) QALYs and $63 040 (95% CI, $37 624-$102 260) for medical management. The incremental cost-effectiveness ratio for catheter ablation compared with medical management was $38 496 (95% CI, $5583-$117 510) per QALY gained. Model inputs with the greatest variation on incremental cost-effectiveness ratio estimates were the cost of ablation and the effect of catheter ablation on mortality reduction. When assuming a more conservative estimate of the treatment effect of catheter ablation on mortality (hazard ratio of 0.86), the estimated incremental cost-effectiveness ratio was $74 403 per QALY gained. At a willingness-to-pay threshold of $100 000 per QALY gained, atrial fibrillation ablation was found to be economically favorable compared with medical management in 95% of simulations. CONCLUSIONS: Catheter ablation in patients with heart failure with reduced ejection fraction patients and atrial fibrillation may be considered economically attractive at current benchmarks for societal willingness-to-pay in the United States.
Full Text
Duke Authors
- Anand, Jatin
- DeVore, Adam David
- Fudim, Marat
- Loring, Zak
- Mark, Daniel Benjamin
- Piccini Sr., Jonathan Paul
- Rymer, Jennifer Anne
- Weimer, Kristin Elizabeth
Cited Authors
- Chew, DS; Loring, Z; Anand, J; Fudim, M; Lowenstern, A; Rymer, JA; Weimer, KED; Atwater, BD; DeVore, AD; Exner, DV; Noseworthy, PA; Yancy, CW; Mark, DB; Piccini, JP
Published Date
- December 2020
Published In
Volume / Issue
- 13 / 12
Start / End Page
- e007094 -
PubMed ID
- 33280436
Pubmed Central ID
- PMC7738404
Electronic International Standard Serial Number (EISSN)
- 1941-7705
Digital Object Identifier (DOI)
- 10.1161/CIRCOUTCOMES.120.007094
Language
- eng
Conference Location
- United States