Kathryn Coyle1, Doug Coyle2, Isabelle Nault3, Ratika Parkash4, Jeffrey S Healey5, Christopher J Gray6, Martin J Gardner6, Laurence D Sterns7, Vidal Essebag8, Tomasz Hruczkowski9, Louis Blier3, George A Wells10, Anthony S L Tang11, William G Stevenson12, John L Sapp13. 1. Health Economics Research Group, Institute of Environment, Health and Societies, Brunel University, London, United Kingdom. 2. Health Economics Research Group, Institute of Environment, Health and Societies, Brunel University, London, United Kingdom; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada. 3. Department of Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec, Canada. 4. Department of Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Canada. 5. Department of Medicine, Population Health Research Institute, Hamilton, Canada. 6. Department of Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Canada; Department of Medicine, Royal Jubilee Hospital, Victoria, Canada. 7. Department of Medicine, Royal Jubilee Hospital, Victoria, Canada. 8. Department of Medicine, McGill University Health Centre and Hôpital Sacre-Coeur de Montreal, Montreal, Canada. 9. University of Alberta, Edmonton, Canada. 10. School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada. 11. Department of Medicine, Western University, London, Canada. 12. Department of Medicine, Vanderbilt University, Nashville, Tennessee. 13. Department of Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Canada. Electronic address: john.sapp@nshealth.ca.
Abstract
OBJECTIVES: This analysis uses the data from the randomized controlled trial to assess the cost effectiveness of catheter ablation (n = 132) versus escalated antiarrhythmic therapy (n = 127). BACKGROUND: For survivors of myocardial infarction with implantable cardioverter-defibrillator shocks despite antiarrhythmic drugs, the VANISH (Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease) trial demonstrated improved clinical outcomes with catheter ablation compared with more aggressive antiarrhythmic pharmacotherapy. METHODS: Health care resource use and quality-of-life data were used to determine the cost effectiveness of catheter ablation. Published references were used to estimate costs (in 2015 Canadian dollars). The analysis was over 3 years, with a 5% discount rate. Adjustment was made for censoring and baseline utilities. RESULTS: Ablation resulted in greater quality-adjusted life-years (QALYs) than escalated drug therapy did (1.63 vs. 1.49; difference: 0.14; 95% confidence interval [CI]: -0.20 to 0.46) and higher cost ($65,126 vs. $60,269; difference: $4,857; 95% CI: -$19,757 to $27,106); with an incremental cost per QALY gained for ablation versus escalated drug therapy of $34,057 primarily due to the initial costs of ablation, which were partially offset by the costs of subsequent ablations and adverse outcomes in the escalated drug therapy arm. For patients with amiodarone-refractory ventricular tachycardia, ablation dominated escalated drug therapy, with greater QALYs (1.48 vs. 1.26; difference: 0.22; 95% CI: -0.19 to 0.59) and lower costs ($67,614 vs. $68,383; difference: -$769; 95% CI: -$35,330 to $27,092). For those with sotalol-refractory ventricular tachycardia, ablation resulted in similar QALYs (1.90 vs. 1.90; difference: -0.00; 95% CI: -0.59 to 0.62) and higher costs ($60,455 vs. $45,033; difference: $15,422; 95% CI: -$10,968 to $48,555). CONCLUSIONS: For the total trial population, results are suggestive that ablation is cost effective compared with escalation of drug therapy. This result was only manifest for the subgroup of patients whose qualifying arrhythmia occurred despite amiodarone.
RCT Entities:
OBJECTIVES: This analysis uses the data from the randomized controlled trial to assess the cost effectiveness of catheter ablation (n = 132) versus escalated antiarrhythmic therapy (n = 127). BACKGROUND: For survivors of myocardial infarction with implantable cardioverter-defibrillator shocks despite antiarrhythmic drugs, the VANISH (Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease) trial demonstrated improved clinical outcomes with catheter ablation compared with more aggressive antiarrhythmic pharmacotherapy. METHODS: Health care resource use and quality-of-life data were used to determine the cost effectiveness of catheter ablation. Published references were used to estimate costs (in 2015 Canadian dollars). The analysis was over 3 years, with a 5% discount rate. Adjustment was made for censoring and baseline utilities. RESULTS: Ablation resulted in greater quality-adjusted life-years (QALYs) than escalated drug therapy did (1.63 vs. 1.49; difference: 0.14; 95% confidence interval [CI]: -0.20 to 0.46) and higher cost ($65,126 vs. $60,269; difference: $4,857; 95% CI: -$19,757 to $27,106); with an incremental cost per QALY gained for ablation versus escalated drug therapy of $34,057 primarily due to the initial costs of ablation, which were partially offset by the costs of subsequent ablations and adverse outcomes in the escalated drug therapy arm. For patients with amiodarone-refractory ventricular tachycardia, ablation dominated escalated drug therapy, with greater QALYs (1.48 vs. 1.26; difference: 0.22; 95% CI: -0.19 to 0.59) and lower costs ($67,614 vs. $68,383; difference: -$769; 95% CI: -$35,330 to $27,092). For those with sotalol-refractory ventricular tachycardia, ablation resulted in similar QALYs (1.90 vs. 1.90; difference: -0.00; 95% CI: -0.59 to 0.62) and higher costs ($60,455 vs. $45,033; difference: $15,422; 95% CI: -$10,968 to $48,555). CONCLUSIONS: For the total trial population, results are suggestive that ablation is cost effective compared with escalation of drug therapy. This result was only manifest for the subgroup of patients whose qualifying arrhythmia occurred despite amiodarone.
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Saenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: J Interv Card Electrophysiol Date: 2020-10 Impact factor: 1.900
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Sáenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: Europace Date: 2019-08-01 Impact factor: 5.214
Authors: Yang Chen; Manuel Gomes; Jason V Garcia; Ross J Hunter; Anthony W Chow; Mehul Dhinoja; Richard J Schilling; Martin Lowe; Pier D Lambiase Journal: Open Heart Date: 2020-01-28
Authors: C Carbucicchio; B A Jereczek-Fossa; D Andreini; V Catto; G Piperno; E Conte; F Cattani; E Rondi; S Vigorito; C Piccolo; A Bonomi; A Gorini; M Pepa; S Mushtaq; G Fassini; M Moltrasio; F Tundo; G Marvaso; F Veglia; R Orecchia; E Tremoli; C Tondo Journal: J Interv Card Electrophysiol Date: 2020-08-27 Impact factor: 1.900
Authors: Indranill Basu-Ray; Dibbendhu Khanra; Sumit K Shah; Anindya Mukherjee; Sudhanva V Char; Bhavna Jain; T Jared Bunch; Michael Gold; Adedayo A Adeboye; Mohammad Saeed Journal: Pacing Clin Electrophysiol Date: 2020-11-30 Impact factor: 1.976