Cost-Effectiveness of Radiofrequency Ablation for Supraventricular Tachycardia in Guatemala: Patient Outcomes and Economic Analysis from a Low- to Middle-Income Country

Abstract

Background: Radiofrequency ablation (RFA) is an established but expensive treatment alternative for many forms of supraventricular tachycardia (SVT). Currently, no studies exist on the cost-effectiveness of RFA compared with that of medical treatment (MT) in adult Latin American population.

Methods: Between 2007 and 2012, we identified 103 adults who underwent RFA for SVT in the National Unit of Cardiovascular Surgery (Unidad Nacional de Cirugía Cardiovascular [UNICAR]) in Guatemala. A decision tree was developed with all clinical outcome parameter estimates obtained from the Adult Electrophysiology Clinic. Cost data were obtained from UNICAR's administration. A cost-effectiveness analysis that evaluated costs and quality-adjusted life-years to compare interventions in terms of their incremental cost-effectiveness ratios was conducted.

Results: The first RFA had an 83% success rate, and a cumulative success rate of 94% was achieved with a second. The cost of the RFA procedure itself was $5411. RFA gained 1.46 quality-adjusted life-years and saved $7993 compared with MT for patients with SVT. This demonstrates that in Guatemala, RFA dominates MT in the management of SVT. Using assumptions based largely on the outcomes in UNICAR, we found that RFA is highly cost-effective. This is a consistent finding, even after varying assumptions about efficacy, complication rates, and quality of life.

Conclusions: RFA dominates MT by improving quality of life and reducing expenditures when used to treat patients with severe symptoms of SVT in Guatemala. The robustness of these finding to variations in parameter assumptions suggests that these findings may hold in other similar settings.

Keywords: cost-effectiveness; quality-adjusted life year; radiofrequency ablation; supraventricular tachycardia.