Is AF Ablation Cost Effective?

Abstract

The use of catheter ablation to treat AF is increasing rapidly, but there is presently an incomplete understanding of its cost-effectiveness. AF ablation procedures involve significant up-front expenditures, but multiple randomized trials have demonstrated that ablation is more effective than antiarrhythmic drugs at maintaining sinus rhythm in a second-line and possibly first-line rhythm control setting. Although truly long-term data are limited, ablation, as compared with antiarrrhythmic drugs, also appears associated with improved symptoms and quality of life and a reduction in downstream hospitalization and other health care resource utilization. Several groups have developed cost effectiveness models comparing AF ablation primarily to antiarrhythmic drugs and the model results suggest that ablation likely falls within the range generally accepted as cost-effective in developed nations. This paper will review available information on the cost-effectiveness of catheter ablation for the treatment of atrial fibrillation, and discuss continued areas of uncertainty where further research is required.

Figure 1.. Incremental Cost-Effectiveness: AF ablation vs. AAD from Reynolds et al., 2009.(24) Reproduced with permission. Tornado diagram displaying the results of key 1-way sensitivity analyses on the iCER for ablation compared with AAD therapy. The base-case result is denoted by the vertical line, and the changes to the iCER by varying individual parameters within plausible limits (shown in parentheses) are shown in the horizontal bars