The cost-effectiveness of radiofrequency catheter ablation as first-line treatment for paroxysmal atrial fibrillation: results from a MANTRA-PAF substudy
Mattias Aronsson, Håkan Walfridsson, Magnus Janzon, Ulla Walfridsson, Jens Cosedis Nielsen, Peter Steen Hansen, Arne Johannessen, Pekka Raatikainen, Gerhard Hindricks, Ole Kongstad, Steen Pehrson, Anders Englund, Juha Hartikainen, Leif Spange Mortensen, Lars-Åke Levin, Mattias Aronsson, Håkan Walfridsson, Magnus Janzon, Ulla Walfridsson, Jens Cosedis Nielsen, Peter Steen Hansen, Arne Johannessen, Pekka Raatikainen, Gerhard Hindricks, Ole Kongstad, Steen Pehrson, Anders Englund, Juha Hartikainen, Leif Spange Mortensen, Lars-Åke Levin
Abstract
Aim: The aim of this prospective substudy was to estimate the cost-effectiveness of treating paroxysmal atrial fibrillation (AF) with radiofrequency catheter ablation (RFA) compared with antiarrhythmic drugs (AADs) as first-line treatment.
Methods and results: A decision-analytic Markov model, based on MANTRA-PAF (Medical Antiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation) study data, was developed to study long-term effects and costs of RFA compared with AADs as first-line treatment. Positive clinical effects were found in the overall population, a gain of an average 0.06 quality-adjusted life years (QALYs) to an incremental cost of €3033, resulting in an incremental cost-effectiveness ratio of €50 570/QALY. However, the result of the subgroup analyses showed that RFA was less costly and more effective in younger patients. This implied an incremental cost-effectiveness ratio of €3434/QALY in ≤50-year-old patients respectively €108 937/QALY in >50-year-old patients.
Conclusion: Radiofrequency catheter ablation as first-line treatment is a cost-effective strategy for younger patients with paroxysmal AF. However, the cost-effectiveness of using RFA as first-line therapy in older patients is uncertain, and in most of these AADs should be attempted before RFA (MANTRA-PAF ClinicalTrials.gov number; NCT00133211).
Keywords: Anti-arrhythmic drugs; Atrial fibrillation; Cost-effectiveness; Radiofrequency ablation.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.
Source: PubMed