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Cost-effectiveness of radiofrequency catheter ablation for the treatment of atrial fibrillation in the UK
  1. Claire McKenna (cm535{at}york.ac.uk)
  1. University of York, United Kingdom
    1. Stephen Palmer (sjp21{at}york.ac.uk)
    1. University of York, United Kingdom
      1. Mark Rodgers
      1. University of York, United Kingdom
        1. Duncan Chambers
        1. University of York, United Kingdom
          1. Neil Hawkins
          1. University of York, United Kingdom
            1. Su Golder
            1. University of York, United Kingdom
              1. Susan Van Hout
              1. University of York, United Kingdom
                1. Chris Pepper
                1. Yorkshire Heart Centre, Leeds, United Kingdom
                  1. Derick Todd
                  1. The Cardiothoracic Centre, Liverpool NHS Trust, United Kingdom
                    1. Nerys Woolacott
                    1. University of York, United Kingdom

                      Abstract

                      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 analytic 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 analytic 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 £7,763 and £7,910 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 £20,000. 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.

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