Cost-effectiveness of Catheter Ablation Versus Antiarrhythmic Drug Therapy for the Treatment of Atrial Fibrillation: A Canadian Perspective

• Main Authors: Yaariv Khaykin, Peter J. Mallow, John A. Rizzo, Atul Verma, Lauren Chun, Shelby Olesovsky, Matthew R. Reynolds
• Format: Article
• Language: English
• Published: Columbia Data Analytics, LLC
• Series: Journal of Health Economics and Outcomes Research
• Online Access: http://jheor.scholasticahq.com/article/9837-cost-effectiveness-of-catheter-ablation-versus-antiarrhythmic-drug-therapy-for-the-treatment-of-atrial-fibrillation-a-canadian-perspective.pdf

**Background:** Atrial fibrillation (AF) affects approximately 350,000 Canadians and has an estimated annual economic burden exceeding $800 million dollars. Anti-arrhythmic drug (AAD) therapy and catheter ablation (CA) are the two common treatments for paroxysmal AF. However, the upfront costs of CA are quite substantial. **Objective:** The objective of this study was to assess the cost-effectiveness of CA compared to AAD for AF based on community practice. **Methods:** A Markov simulation model was developed for a hypothetical cohort of 55-year-old patients with paroxysmal AF and a low stroke risk. Patients received either CA or AAD. Costs and quality-adjusted life years (QALYs) were computed over lifetime, 10-year, and 5-year time horizons. Model inputs were obtained from a large, prospectively collected, single-center Canadian registry and augmented with the published literature, using Canadian cost estimates for disease states. Threshold values of $25,000, $50,000, and $100,000 per QALY, respectively, were used to determine cost-effectiveness. All costs were expressed in 2012 Canadian dollars. **Results:** The incremental cost-effectiveness ratio for CA versus AAD therapy was $1,228, $22,879, and $63,647 for the lifetime, 10-year, and 5-year time horizons, respectively. Over a lifetime horizon, the probability of achieving cost-effectiveness was 100% for all 3 cost per QALY thresholds. The 10-year probability of achieving cost-effectiveness was 74%, 100%, and 100% at the $25,000, $50,000, and $100,000 thresholds, respectively. The 5-year probability of achieving cost-effectiveness was 0%, 0.9%, and 100% at the 3 cost per QALY thresholds. Results were most sensitive to time horizon, probability of repeat AF ablation, and stroke rate. **Conclusions:** From the perspective of the Canadian Healthcare system, CA is a potentially cost-effective treatment compared to AAD therapy in a low stroke risk population using real-world data when examining a time horizon of greater than 5 years.