Economic analysis of CABANA trial reveals economic advantages of catheter ablation over pharmacotherapy

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Aug 3, 2021 – A new analysis of the CABANA trial (Catheter Ablation vs. Antiarrhythmic Drug Therapy for Atrial Fibrillation) examines the cost-effectiveness of catheter ablation versus drug therapy. CABANA is the largest trial comparing catheter ablation with drug therapy and is the first cost and benefit analysis of ablation using patient-level data.

The results of the economic analysis were presented as a late-breaking clinical trial as part of Heart Rhythm 2021, the annual meeting of the Heart Rhythm Society (HRS).

Atrial fibrillation (AF) affects more than 60 million people worldwide[1] and accounts for up to $ 26 billion in health care costs in the United States alone. In fact, the annual medical costs for patients with AF are 73% higher than those with no condition.[2] With the growing population of patients with AF and the economic burden on patients, there is an increased need for cost-effective treatments. While the CABANA trial had previously demonstrated improvements in quality of life, freedom from AF recurrence, and a decrease in AF burden compared to drug treatment, cost and outcome data were limited to less robust trials.

An economic analysis was conducted using patient-level data collected prospectively during the CABANA trial. This included data on resource use such as hospitalizations, procedures and emergency department visits reported by the 2,204 enrolled patients and hospital costs estimated from fees using cost-to-burden ratios at the level. service for 1,171 US patients with billing data. The quality of life adjustment factors were based on the utilities directly measured in the CABANA trial and the cost-effectiveness was assessed from a health care perspective in the United States over a lifetime .

The results highlight that, when adjusted for improvements in quality of life, catheter ablation offers positive economic results. The estimated additional cost per quality-adjusted life year (QALY) gained with catheter ablation is $ 57,433, which is within the value thresholds conventionally accepted in the US healthcare system. While the costs of catheter ablation compared to drug therapy were significantly higher (attributed to the initial cost of ablation: mean $ 26,656 ± standard deviation 9,123) during the first three months of follow-up, it there were no significant differences in costs beyond 12 months. Patients assigned to ablation accumulated an average of 12.6 years of life (LY) and 11.0 QALY for a total cumulative cost of $ 150,987 (95% CI 145,420 – 169,208). While patients assigned to drug therapy accumulated on average 12.5 LY and 10.7 QALY for a total cumulative cost of $ 135,594 (95% CI 129,918 – 155,884).

“As clinicians, we have seen firsthand the benefits of catheter ablation in controlling irregular heartbeats – and now we also have economic evidence to support this treatment option as a viable option for our patients. “, said Derek Chew, MD, MSci and Daniel Mark, MD, MPH, Duke Clinical Research Institute, the principal authors of the economic analysis of the CABANA trial. “Additionally, in an era of rising healthcare costs, it is increasingly important to provide value-based care for progressive conditions such as AF. “

The authors note that further analyzes of CABANA will be conducted to further determine cost-effectiveness for patients with heart failure and other key subgroups.

The economic analysis of the CABANA trial was partially funded by grants from the National, Heart, Lung, and Blood Institute.

Related CABANA content:

Historic CABANA trial confirms ablation equals or exceeds drug therapy

VIDEO: Key Trends in Electrophysiology – Apple Watch for Detecting AF and the CABANA Test Interview with Christina Albert, MD

Find other HRS 2021 late failure tests

Find more news about EP devices

Find more news about the HRS 2021 conference

The references:

1. Roth GA, Mensah GA, Johnson CO et al. Global Burden of Cardiovascular Disease and Risk Factors, 1990-2019: GBD Study 2019 Update. J Am Coll Cardiol 2020; 76: 2982-3021.

2. Kim, Michael H., et al. “Estimation of Total Incremental Health Care Costs in Patients with Atrial Fibrillation in the United States.” Circulation: Cardiovascular Quality and Outcomes, vol. 4, no. 3, 2011, p. 313-320., Doi: 10.1161 / circoutcomes.110.958165.


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