Mattias Aronsson1, Håkan Walfridsson2, Magnus Janzon2, Ulla Walfridsson3, Jens Cosedis Nielsen4, Peter Steen Hansen4, Arne Johannessen5, Pekka Raatikainen6, Gerhard Hindricks7, Ole Kongstad8, Steen Pehrson9, Anders Englund10, Juha Hartikainen11, Leif Spange Mortensen12, Lars-Åke Levin13. 1. Department of Medical and Health Sciences, Linköping University, Linköping, Sweden mattias.aronsson@liu.se. 2. Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. 3. Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Department of Medical and Health Sciences, Division of Nursing Science, Linkoping University, Linkoping, Sweden. 4. Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. 5. Gentofte University Hospital, Copenhagen, Denmark. 6. Heart Center Co., Tampere University Hospital, Tampere, Finland. 7. Leipzig University Hospital, Leipzig, Germany. 8. Lund University Hospital, Lund, Sweden. 9. Rigshospitalet, Copenhagen, Denmark. 10. University Hospital, Örebro, Sweden. 11. Heart Center, Kuopio University Hospital, Kuopio, Finland. 12. Danish Information Technology Centre for Education and Research, Aarhus, Denmark. 13. Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Abstract
AIM: The aim of this prospective substudy was to estimate the cost-effectiveness of treating paroxysmal atrial fibrillation (AF) with radiofrequency catheter ablation (RFA) compared with antiarrhythmic drugs (AADs) as first-line treatment. METHODS AND RESULTS: A decision-analytic Markov model, based on MANTRA-PAF (Medical Antiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation) study data, was developed to study long-term effects and costs of RFA compared with AADs as first-line treatment. Positive clinical effects were found in the overall population, a gain of an average 0.06 quality-adjusted life years (QALYs) to an incremental cost of €3033, resulting in an incremental cost-effectiveness ratio of €50 570/QALY. However, the result of the subgroup analyses showed that RFA was less costly and more effective in younger patients. This implied an incremental cost-effectiveness ratio of €3434/QALY in ≤50-year-old patients respectively €108 937/QALY in >50-year-old patients. CONCLUSION:Radiofrequency catheter ablation as first-line treatment is a cost-effective strategy for younger patients with paroxysmal AF. However, the cost-effectiveness of using RFA as first-line therapy in older patients is uncertain, and in most of these AADs should be attempted before RFA (MANTRA-PAF ClinicalTrials.gov number; NCT00133211). Published on behalf of the European Society of Cardiology. All rights reserved.
RCT Entities:
AIM: The aim of this prospective substudy was to estimate the cost-effectiveness of treating paroxysmal atrial fibrillation (AF) with radiofrequency catheter ablation (RFA) compared with antiarrhythmic drugs (AADs) as first-line treatment. METHODS AND RESULTS: A decision-analytic Markov model, based on MANTRA-PAF (Medical Antiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation) study data, was developed to study long-term effects and costs of RFA compared with AADs as first-line treatment. Positive clinical effects were found in the overall population, a gain of an average 0.06 quality-adjusted life years (QALYs) to an incremental cost of €3033, resulting in an incremental cost-effectiveness ratio of €50 570/QALY. However, the result of the subgroup analyses showed that RFA was less costly and more effective in younger patients. This implied an incremental cost-effectiveness ratio of €3434/QALY in ≤50-year-old patients respectively €108 937/QALY in >50-year-old patients. CONCLUSION: Radiofrequency catheter ablation as first-line treatment is a cost-effective strategy for younger patients with paroxysmal AF. However, the cost-effectiveness of using RFA as first-line therapy in older patients is uncertain, and in most of these AADs should be attempted before RFA (MANTRA-PAF ClinicalTrials.gov number; NCT00133211). Published on behalf of the European Society of Cardiology. All rights reserved.
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