“Good value” catheter ablation in CABANA’s economic analysis

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The cost-effectiveness of ablation versus drug therapy was driven by improving quality of life, not reducing difficult events.

Radiofrequency ablation for atrial fibrillation (AF) is an “economically attractive” option over drug therapy, according to a new cost-effectiveness analysis of the CABANA trial.

Presented last week at the 2021 Heart Rhythm Society Science Sessions, the pre-defined analysis showed the differential cost-effectiveness (ICER) for ablation to be $ 57,433 per quality-adjusted life year (QALY ) earned, which is consistent with current affordability thresholds, the researchers say.

“This hits the threshold of good quality care in the United States,” said principal investigator Derek Chew, MD (Duke Clinical Research Institute, Durham, NC), in a last-minute clinical trial session . In the United States, the American College of Cardiology and the American Heart Association consider treatments with an ICER ranging from $ 50,000 to $ 150,000 per QALY to be of intermediate value (less than $ 50,000 is considered to be of value high and over $ 150,000 as low value).

Chew pointed out that CABANA missed its primary endpoint – radiofrequency ablation did not significantly reduce all-cause mortality, disabling strokes, severe bleeding or cardiac arrest compared to treatment. drug in 2,204 patients with recent onset or undertreated AF. However, there were significant improvements in quality of life, freedom from AF recurrence and AF burden.

The economics of catheter ablation to improve quality of life or reduce symptom burden are important in this era of escalating value-based health and care costs, Chew said. “Whatever expensive therapy we offer our patients, we want to make sure it’s of good value,” he said.

Also good value in patients with heart failure

The lifetime costs of ablation and drug therapy with rate and / or rhythm control were $ 150,987 and $ 135,594, respectively. The number of years of life gained with ablation has been estimated at 12.63 and 12.54 with drug treatment. Based on the respective QALYs of 11.01 and 10.74 for ablation and drug treatment, the ICER for ablation versus medical treatment was found to be economically viable.

“Profitability has been driven by gains in quality of life,” Chew said. “When we looked at the life expectancy between the two groups (ablation versus drug therapy), there was really no difference, which is consistent with the results of the main study. ”

In a subgroup of 778 patients with heart failure in CABANA—Where the primary endpoint was reduced with ablation, as was all-cause mortality — the ICER was $ 54,321 per QALY gained. Here, the cost-effectiveness of ablation over drug therapy was due to differences in mortality as well as quality of life, Chew said.

Speaking in the last session, Mark Link, MD (UT Southwestern Medical Center, Dallas, TX) commended study investigators for the new data, noting that a number of CABANA sub-analyzes are starting to emerge. emerge from the main test.

But in terms of economic analysis, Link, along with panelist Kimberley Selzman, MD (University of Utah, Salt Lake City), asked why the costs of catheter ablation and medical treatment were so similar. In response, Chew said the majority of the cost differences between ablation and drug treatment accumulated during the first year of follow-up, which was mainly due to the cost of the procedure. The high crossover rate with ablation (27.5%) increased costs in the drug therapy arm, Chew said. For this reason, Link suggested, it might be interesting to see an economic analysis based on patients who received the assigned treatment (per protocol).

“I agree that this is not the formal way to evaluate an essay, but it is more of a real world analysis,” Link said.


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