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November 9, 2018Current Medical Research and Opinion

The Cox maze procedure yielded lower 1-year mortality (3.5% vs 8.5%) and higher QALYs than catheter ablation, with a lifetime incremental cost-effectiveness ratio of $12,794 per QALY gained.

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Why the study?

Is the Cox maze procedure cost-effective compared to catheter ablation in patients with atrial fibrillation?

Population

Patients with atrial fibrillation

Comparison

Cox maze procedure vs Catheter ablation

Design

Other

Follow-up

1 year and lifetime (projected)

Key result

The Cox maze procedure yielded lower 1-year mortality (3.5% vs 8.5%) and higher QALYs than catheter ablation, with a lifetime incremental cost-effectiveness ratio of $12,794 per QALY gained.

Authors

YYY. Tony YangJOJesse D. Ortendahl

Discussion

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Member takes

Overview

Cox maze may be cost-effective versus catheter ablation in AF at common thresholds; leaves open need for randomized confirmation of model inputs.

Structured PICO

Is the Cox maze procedure cost-effective compared to catheter ablation in patients with atrial fibrillation?

P
Population
Model-based cost-effectiveness analysis of patients with atrial fibrillation comparing the Cox maze procedure to catheter ablation over 1-year and lifetime horizons.
I
Intervention
Cox maze procedure
C
Comparator
Catheter ablation
O
Outcome
Cost-effectiveness ratio in $/QALY

The Cox maze procedure appears to be a highly cost-effective alternative to catheter ablation for atrial fibrillation, increasing quality-adjusted survival at an acceptable societal cost.

Limitations

  • Results were most sensitive to the likelihood of improvement following each intervention and the cost of the initial procedure

Cite This Study

Yang et al. (2018) studied atrial fibrillation. Cox maze procedure vs. catheter ablation was evaluated on lifetime incremental cost-effectiveness ratio ($/QALY). The Cox maze procedure yielded lower 1-year mortality (3.5% vs 8.5%) and higher QALYs than catheter ablation, with a lifetime incremental cost-effectiveness ratio of $12,794 per QALY gained.

synapsesocial.com/papers/6aaf53254104dfdc38ce9b6fhttps://doi.org/10.1080/03007995.2018.1546681
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1A randomised controlled trial and cost-effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in people aged 65 and over. The SAFE study2005 · 438 citations
  2. 2Subclinical Atrial Fibrillation and the Risk of Stroke2012 · 2,113 citations
  3. 3Impact of Atrial Fibrillation on the Risk of Death1998 · 4,611 citations
  4. 4Preference-Based EQ-5D Index Scores for Chronic Conditions in the United States2006 · 722 citations
  5. 5The cost-effectiveness of Maze procedures using ablation techniques at the time of mitral valve surgery2009 · 20 citations