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. 2023 Apr;16(4):e011237.
doi: 10.1161/CIRCEP.122.011237. Epub 2023 Mar 9.

Economic and Health Value of Delaying Atrial Fibrillation Progression Using Radiofrequency Catheter Ablation

Adam E Berman  1 , Mina Kabiri  2 , Tom Wei  3 , Thibaut Galvain  2 , Qun Sha  4 , Karl-Heinz Kuck  5   6
Affiliations

Economic and Health Value of Delaying Atrial Fibrillation Progression Using Radiofrequency Catheter Ablation

Adam E Berman et al. Circ Arrhythm Electrophysiol. 2023 Apr.

Abstract

Background: Radiofrequency catheter ablation (RFCA) is an established treatment for atrial fibrillation (AF) refractory to antiarrhythmic drugs. The economic value of RFCA in delaying disease progression has not been quantified.

Methods: An individual-level, state-transition health economic model estimated the impact of delayed AF progression using RFCA versus antiarrhythmic drug treatment for a hypothetical sample of patients with paroxysmal AF. The model incorporated the lifetime risk of progression from paroxysmal AF to persistent AF, informed by data from the ATTEST (Atrial Fibrillation Progression Trial). The incremental effect of RFCA on disease progression was modeled over a 5-year duration. Annual crossover rates were also included for patients in the antiarrhythmic drug group to mirror clinical practice. Estimates of discounted costs and quality-adjusted life years asssociated with health care utilization, clinical outcomes, and complications were projected over patients' lifetimes.

Results: From the payer's perspective, RFCA was superior to antiarrhythmic drug treatment with an estimated mean net monetary benefit per patient of $8516 ($148-$16 681), driven by reduced health care utilization, cost, and improved quality-adjusted life years. RFCA reduced mean (95% CI) per-patient costs by $73 (-$2700 to $2200), increased mean quality-adjusted life years by 0.084 (0.0-0.17) and decreased the mean number of cardiovascular-related health care encounters by 24%.

Conclusions: RFCA is a dominant (less costly and more effective) treatment strategy for patients with AF, especially those with early AF for whom RFCA could delay progression to advanced AF. Increased utilization of RFCA-particularly among patients earlier in their disease progression-may provide clinical and economic benefits.

Keywords: atrial fibrillation; catheter ablation; disease progression; humans; quality of life.

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Conflict of interest statement

Dr Berman has acted as a consultant for Biosense Webster, Inc. Dr Kuck has acted as a consultant for Medtronic, Boston Scientific, Biosense Webster, Inc, Abbott, and Edwards Lifesciences. Dr Kabiri, T. Wei, T. Galvain, and Dr Sha are employees of Johnson & Johnson, which is parent to Biosense Webster, Inc. Drs Berman, Kabiri, Sha, and T. Wei provided substantial contributions to study concept and design. Dr Kabiri and T. Galvain provided significant contributions towards data analysis. Drs Berman, Kabiri, Kuck, and T. Wei provided significant contribution into critical interpretation of the work. All authors contributed towards article drafting.

Figures

Figure 1.
Figure 1.
Atrial fibrillation (AF) state-transition model. At any given time, a patient’s health state was represented by one of the states shown by rectangles. Solid arrows between states represented possible transitions based on model cycle (3 months) probabilities. Patients received either radiofrequency catheter ablation (RFCA) or antiarrhythmic drugs (AADs) in the first cycle and transitioned from paroxysmal AF (PAF) to a sinus rhythm state for the next cycle. In subsequent cycles, patients could experience PAF recurrence, progression to advanced AF (with persistent AF [PsAF] occurrence), experience disabling stroke, or maintain sinus rhythm. Advanced AF did not represent a patient’s exact rhythm status over the simulation period but was intended to characterize patients with more severe AF disease. Transition to death was included from all states.
Figure 2.
Figure 2.
Proportion of patients in each health state over time for radiofrequency catheter ablation (RFCA) and antiarrhythmic drug (AAD) treatment scenarios. A, Base case analysis: 5-year incremental treatment effect of RFCA compared with AADs. B, Scenario analysis: 10-year incremental treatment effect of RFCA compared with AADs. Gray zones indicate treatment effect duration/period in each scenario.
Figure 3.
Figure 3.
Incremental cost-effectiveness scatterplot. The incremental cost-effectiveness scatterplot illustrates the incremental cost versus incremental effectiveness of the radiofrequency catheter ablation (RFCA) scenario compared with antiarrhythmic drug (AAD) scenario for all simulation iterations. Orange line indicates willingness-to-pay threshold of $100 000 per quality-adjusted life year. QALY indicates quality-adjusted life year.
Figure 4.
Figure 4.
Cost-effectiveness acceptability curve. AAD indicates antiarrhythmic drug; and RFCA, radiofrequency catheter ablation.
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