Does radiofrequency catheter ablation improve cost-effectiveness and quality-adjusted life years compared to anti-arrhythmic drug therapy in patients with paroxysmal atrial fibrillation?
Radiofrequency catheter ablation is highly likely to be cost-effective for treating paroxysmal atrial fibrillation refractory to anti-arrhythmic drugs in the UK NHS, provided quality-of-life benefits are maintained for more than 5 years.
OBJECTIVE: To assess the cost-effectiveness of radiofrequency catheter ablation (RFCA) compared with anti-arrhythmic drug (AAD) therapy for the treatment of atrial fibrillation (AF) from the perspective of the UK NHS. DESIGN: Bayesian evidence synthesis and decision analytical model. METHODS: A systematic review and meta-analysis was conducted and Bayesian statistical methods used to synthesise the effectiveness evidence from randomised control trials. A decision analytical model was developed to assess the costs and consequences associated with the primary outcome of the trials over a lifetime time horizon. MAIN OUTCOME MEASURE: Costs from a health service perspective and outcomes measured as quality-adjusted life years (QALYs). RESULTS: The incremental cost-effectiveness ratio of RFCA varied between pound7763 and pound7910 for each additional QALY according to baseline risk of stroke, with a probability of being cost-effective from 0.98 to 0.99 for a cost-effectiveness threshold of pound20 000. Results were sensitive to the duration of quality of life benefits from treatment. CONCLUSIONS: RFCA is potentially cost-effective for the treatment of paroxysmal AF in patients' predominantly refractory to AAD therapy provided the quality-of-life benefits from treatment are maintained for more than 5 years. These findings remain subject to limitations in the existing evidence regarding the nature of life benefits and the prognostic importance of restoring normal sinus rhythm conferred using RFCA.
McKenna et al. (Thu,) studied this question.