Cost-effectiveness of radiofrequency catheter ablation as first-line treatment for paroxysmal atrial fibrillation

Abstract

Background: Radiofrequency catheter ablation (RFA) of patients with atrial fibrillation who already failed at least one antiarrhythmic drug (AAD) has previously been proven both clinical efficient and cost-effective. It has been suggested that RFA could take priority over antiarrhythmic drugs as first-line treatment, because of better efficiency treating atrial fibrillation and fewer serious side effects. The MANTRA-PAF-study (The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation) is the first published, large, randomized multicenter trial of the clinical effects of such implementation in patients with paroxysmal atrial fibrillation. Purpose(s): The aim of this study was to evaluate the cost-effectiveness of treating paroxysmal atrial fibrillation with radiofrequency catheter ablation as first-line treatment Methods and Results: Costs and clinical effects for the first two years were calculated direct from MANTRA-PAF data. A decision analytic Markov-model was developed to study long-term (life-long) effects and costs of RFA compared to AAD as first-line treatment. Small positive clinical effects were found in the overall population, a gain of average 0.06 QALYs to an incremental cost of 3,033 resulting in an incremental cost-effectiveness ratio (ICER) of 50,570 /QALY However, the result of the subgroup analyses indicates that a major part of the positive clinical effects for the overall population were from the quartile (26%) of the youngest patients (<50 years). Older patients were also relatively costly to treat while younger were almost cost neutral when using a life-long perspective. The ICER of a 45 years old patient was approximately 3,434 /QALY, while corresponding ICER of a 65 years old patient was 108,937 /QALY Conclusion(s): Cather ablation seems to be a cost-effective treatment option for patients below 50 years with paroxysmal atrial fibrillation. However, the effectiveness in older patients is uncertain.