Skip to main content

Economic Evaluation of Catheter Ablation of Atrial Fibrillation in Patients with Heart Failure With Reduced Ejection Fraction.

Publication ,  Journal Article
Chew, DS; Loring, Z; Anand, J; Fudim, M; Lowenstern, A; Rymer, JA; Weimer, KED; Atwater, BD; DeVore, AD; Exner, DV; Noseworthy, PA; Yancy, CW ...
Published in: Circ Cardiovasc Qual Outcomes
December 2020

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.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

December 2020

Volume

13

Issue

12

Start / End Page

e007094

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Treatment Outcome
  • Time Factors
  • Stroke Volume
  • Quality-Adjusted Life Years
  • Quality of Life
  • Markov Chains
  • Humans
  • Heart Failure
  • Health Care Costs
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Chew, D. S., Loring, Z., Anand, J., Fudim, M., Lowenstern, A., Rymer, J. A., … Piccini, J. P. (2020). Economic Evaluation of Catheter Ablation of Atrial Fibrillation in Patients with Heart Failure With Reduced Ejection Fraction. Circ Cardiovasc Qual Outcomes, 13(12), e007094. https://doi.org/10.1161/CIRCOUTCOMES.120.007094
Chew, Derek S., Zak Loring, Jatin Anand, Marat Fudim, Angela Lowenstern, Jennifer A. Rymer, Kristin E. D. Weimer, et al. “Economic Evaluation of Catheter Ablation of Atrial Fibrillation in Patients with Heart Failure With Reduced Ejection Fraction.Circ Cardiovasc Qual Outcomes 13, no. 12 (December 2020): e007094. https://doi.org/10.1161/CIRCOUTCOMES.120.007094.
Chew DS, Loring Z, Anand J, Fudim M, Lowenstern A, Rymer JA, et al. Economic Evaluation of Catheter Ablation of Atrial Fibrillation in Patients with Heart Failure With Reduced Ejection Fraction. Circ Cardiovasc Qual Outcomes. 2020 Dec;13(12):e007094.
Chew, Derek S., et al. “Economic Evaluation of Catheter Ablation of Atrial Fibrillation in Patients with Heart Failure With Reduced Ejection Fraction.Circ Cardiovasc Qual Outcomes, vol. 13, no. 12, Dec. 2020, p. e007094. Pubmed, doi:10.1161/CIRCOUTCOMES.120.007094.
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. Economic Evaluation of Catheter Ablation of Atrial Fibrillation in Patients with Heart Failure With Reduced Ejection Fraction. Circ Cardiovasc Qual Outcomes. 2020 Dec;13(12):e007094.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

December 2020

Volume

13

Issue

12

Start / End Page

e007094

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Treatment Outcome
  • Time Factors
  • Stroke Volume
  • Quality-Adjusted Life Years
  • Quality of Life
  • Markov Chains
  • Humans
  • Heart Failure
  • Health Care Costs