RT Journal Article
SR Electronic
T1 Cost-effectiveness of radiofrequency catheter ablation for the treatment of atrial fibrillation in the United Kingdom
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 542
OP 549
DO 10.1136/hrt.2008.147165
VO 95
IS 7
A1 C McKenna
A1 S Palmer
A1 M Rodgers
A1 D Chambers
A1 N Hawkins
A1 S Golder
A1 S Van Hout
A1 C Pepper
A1 D Todd
A1 N Woolacott
YR 2009
UL http://heart.bmj.com/content/95/7/542.abstract
AB 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 £7763 and £7910 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.