Key result
Catheter ablation for ventricular tachycardia had an ICER of £144,150 per QALY gained compared with AAD therapy, with only an 11% likelihood of being cost-effective at a £30,000 threshold.
Why the study?
Catheter ablation is an important treatment that reduces ventricular tachycardia episodes, but its cost-effectiveness compared with antiarrhythmic drug therapy required evaluation.
Is catheter ablation cost-effective compared to antiarrhythmic drug therapy in patients with ischaemic cardiomyopathy and an ICD?
Is catheter ablation cost-effective compared to antiarrhythmic drug therapy in patients with ischaemic cardiomyopathy and an ICD?
Effect estimate: ICER £144 150
Catheter ablation for VT in ischemic cardiomyopathy is unlikely to be cost-effective compared to AAD therapy based on current RCT evidence, largely due to limited quality of life data.
VT ablation unlikely cost-effective at standard thresholds vs AADs; leaves open whether improved QoL data would change value.
Objective: Catheter ablation is an important treatment for ventricular tachycardia (VT) that reduces the frequency of episodes of VT. We sought to evaluate the cost-effectiveness of catheter ablation versus antiarrhythmic drug (AAD) therapy. Methods: A decision-analytic Markov model was used to calculate the costs and health outcomes of catheter ablation or AAD treatment of VT for a hypothetical cohort of patients with ischaemic cardiomyopathy and an implantable cardioverter-defibrillator. The health states and input parameters of the model were informed by patient-reported health-related quality of life (HRQL) data using randomised clinical trial (RCT)-level evidence wherever possible. Costs were calculated from a 2018 UK perspective. Results: Catheter ablation versus AAD therapy had an incremental cost-effectiveness ratio (ICER) of £144 150 (€161 448) per quality-adjusted life-year gained, over a 5-year time horizon. This ICER was driven by small differences in patient-reported HRQL between AAD therapy and catheter ablation. However, only three of six RCTs had measured patient-reported HRQL, and when this was done, it was assessed infrequently. Using probabilistic sensitivity analyses, the likelihood of catheter ablation being cost-effective was only 11%, assuming a willingness-to-pay threshold of £30 000 used by the UK's National Institute for Health and Care Excellence. Conclusion: Catheter ablation of VT is unlikely to be cost-effective compared with AAD therapy based on the current randomised trial evidence. However, better designed studies incorporating detailed and more frequent quality of life assessments are needed to provide more robust and informed cost-effectiveness analyses.
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Chen et al. (2020) studied Ventricular tachycardia in ischaemic cardiomyopathy. Catheter ablation vs. Antiarrhythmic drug (AAD) therapy was evaluated on Incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year gained (ICER £144 150). Catheter ablation for ventricular tachycardia had an ICER of £144,150 per QALY gained compared with AAD therapy, with only an 11% likelihood of being cost-effective at a £30,000 threshold.
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