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

Berman, AE, Kabiri, M, Wei, T, Galvain, T, Sha, Q and Kuck, KH (2023) Economic and Health Value of Delaying Atrial Fibrillation Progression Using Radiofrequency Catheter Ablation. Circulation: Arrhythmia and Electrophysiology, 16 (4). ISSN 1941-3149

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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.

Item Type: Article
Uncontrolled Keywords: Humans; Atrial Fibrillation; Disease Progression; Recurrence; Anti-Arrhythmia Agents; Catheter Ablation; Treatment Outcome; atrial fibrillation; catheter ablation; disease progression; humans; quality of life; Humans; Atrial Fibrillation; Anti-Arrhythmia Agents; Treatment Outcome; Catheter Ablation; Disease Progression; Recurrence; 1102 Cardiorespiratory Medicine and Haematology; 1103 Clinical Sciences; 1116 Medical Physiology; Cardiovascular System & Hematology
Subjects: Q Science > QA Mathematics > QA75 Electronic computers. Computer science
R Medicine > R Medicine (General)
Divisions: Computer Science & Mathematics
Publisher: Ovid Technologies (Wolters Kluwer Health)
SWORD Depositor: A Symplectic
Date Deposited: 19 May 2023 10:46
Last Modified: 19 May 2023 11:00
DOI or ID number: 10.1161/CIRCEP.122.011237
URI: https://researchonline.ljmu.ac.uk/id/eprint/19534
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