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CLINICAL RESEARCH

Cost-Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation

Paul S. Chan, MD, MSc^_*,,_*, Sandeep Vijan, MD, MSc^,, Fred Morady, MD^_* and Hakan Oral, MD^_*

^_* Division of Cardiology, University of Michigan School of Medicine, Ann Arbor, Michigan
VA Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan

Manuscript received December 23, 2005; revised manuscript received January 27, 2006, accepted January 30, 2006.

^_* Reprint requests and correspondence: Dr. Paul S. Chan, VA Center for Practice Management and Outcomes Research, PO Box 130170, Ann Arbor, Michigan 48113-0170 (Email: paulchan{at}umich.edu).

OBJECTIVES: We sought to compare the cost-effectiveness of left atrial catheter ablation (LACA), amiodarone, and rate control therapy in the management of atrial fibrillation (AF).

BACKGROUND: Left atrial catheter ablation has been performed to eliminate AF, but its cost-effectiveness is unknown.

METHODS: We developed a decision-analytic model to evaluate the cost-effectiveness of LACA in 55- and 65-year-old cohorts with AF at moderate and low stroke risk. Costs, health utilities, and transition probabilities were derived from published literature and Medicare data. We performed primary threshold analyses to determine the minimum level of LACA efficacy and stroke risk reduction needed to make LACA cost-effective at $50,000 and $100,000 per quality-adjusted life-year (QALY) thresholds.

RESULTS: In 65-year-old subjects with AF at moderate stroke risk, relative reduction in stroke risk with an 80% LACA efficacy rate for sinus rhythm restoration would need to be 42% and 11% to yield incremental cost-effectiveness ratios (ICERs) <$50,000 and $100,000 per QALY, respectively. Higher and lower LACA efficacy rates would require correspondingly lower and higher stroke risk reduction for equivalent ICER thresholds. In the 55-year-old moderate stroke risk cohort, lower LACA efficacy rates or stroke risk reduction would be needed for the same ICER thresholds. In patients at low stroke risk, LACA was unlikely to be cost-effective.

CONCLUSIONS: The use of LACA may be cost-effective in patients with AF at moderate risk for stroke, but it is not cost-effective in low-risk patients. Our threshold analyses may provide a framework for the design of future clinical trials by providing effect size estimates for LACA efficacy needed.

Abbreviations and Acronyms   AF = atrial fibrillation   ICER = incremental cost-effectiveness ratio   LACA = left atrial catheter ablation   QALY = quality-adjusted life-years

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