Abstract
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.
Highlights
350,000 Canadians are currently affected by atrial fibrillation (AF).[1]
Results were most sensitive to time horizon, probability of repeat Atrial fibrillation (AF) ablation, and stroke rate
From the perspective of the Canadian Healthcare system, catheter ablation (CA) is a potentially cost-effective treatment compared to Anti-arrhythmic drug (AAD) therapy in a low stroke risk population using real-world data when examining a time horizon of greater than 5 years
Summary
350,000 Canadians are currently affected by atrial fibrillation (AF).[1] This condition is characterized by disorganized, rapid, and irregular heartbeat. Patients with AF are at increased risk of subsequent stroke, morbidity, and mortality.[2,3,4] The rate of hospitalization for AF in Canada was approximately 583 per 100,000 people between 1997 and 2000, with an average of 129,000 hospitalizations per year.[5] As a result, the aggregate economic burden of AF, including initial costs as well as over the longer term, are quite substantial. A recent study examining the hospital costs associated with AF found the burden to exceed $800 million (2010 Canadian Dollars).[6]. Atrial fibrillation (AF) affects approximately 350,000 Canadians and has an estimated annual economic burden exceeding $800 million dollars.
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