Cited by 87Cardiac Arrhythmias and TreatmentsHealth Systems, Economic Evaluations, Quality of LifeAtrial Fibrillation Management and Outcomes

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Cost-Effectiveness of Radiofrequency Ablation for Supraventricular Tachycardia

Cheng, Carol H.F., Sanders, Gillian D., Hlatky, Mark A., Heidenreich, Paul, McDonald, Kathryn M., Lee, Byron K., Larson, Mary S., Owens, Douglas K.·2000·Annals of Internal Medicine

DOI 10.7326/0003-4819-133-11-200012050-00010

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Abstract

BACKGROUND: Radiofrequency ablation is an established but expensive treatment option for many forms of supraventricular tachycardia. Most cases of supraventricular tachycardia are not life-threatening; the goal of therapy is therefore to improve the patient's quality of life. OBJECTIVE: To compare the cost-effectiveness of radiofrequency ablation with that of medical management of supraventricular tachycardia. DESIGN: Markov model. DATA SOURCES: Costs were estimated from a major academic hospital and the literature, and treatment efficacy was estimated from reports from clinical studies at major medical centers. Probabilities of clinical outcomes were estimated from the literature. To account for the effect of radiofrequency ablation on quality of life, assessments by patients who had undergone the procedure were used. TARGET POPULATION: Cohort of symptomatic patients who experienced 4.6 unscheduled visits per year to an emergency department or a physician's office while receiving long-term drug therapy for supraventricular tachycardia. TIME HORIZON: Patient lifetime. PERSPECTIVE: Societal. INTERVENTIONS: Initial radiofrequency ablation, long-term antiarrhythmic drug therapy, and treatment of acute episodes of arrhythmia with antiarrhythmic drugs. OUTCOME MEASURES: Costs, quality-adjusted life-years, life-years, and marginal cost-effectiveness ratios. RESULTS OF BASE-CASE ANALYSIS: Among patients who have monthly episodes of supraventricular tachycardia, radiofrequency ablation was the most effective and least expensive therapy and therefore dominated the drug therapy options. Radiofrequency ablation improved quality-adjusted life expectancy by 3.10 quality-adjusted life-years and reduced lifetime medical expenditures by $27 900 compared with long-term drug therapy. Long-term drug therapy was more effective and had lower costs than episodic drug therapy. RESULTS OF SENSITIVITY ANALYSIS: The findings were highly robust over substantial variations in assumptions about the efficacy and complication rate of radiofrequency ablation, including analyses in which the complication rate was tripled and efficacy was decreased substantially. CONCLUSIONS: Radiofrequency ablation substantially improves quality of life and reduces costs when it is used to treat highly symptomatic patients. Although the benefit of radiofrequency ablation has not been studied in less symptomatic patients, a small improvement in quality of life is sufficient to give preference to radiofrequency ablation over drug therapy.

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Authors: Cheng, C. H. F., Sanders, G. D., Hlatky, M. A., Heidenreich, P., McDonald, K. M., Lee, B. K., Larson, M. S., & Owens, D. K.
Affiliations: VA Palo Alto Health Care System (US)
ORCID: Sanders, Gillian D.
Hlatky, Mark A.
Heidenreich, Paul
McDonald, Kathryn M.
Lee, Byron K.
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 2000-12-05
Volume: 133
Issue: 11
Pages: 864-876
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/0003-4819-133-11-200012050-00010
OpenAlex: W1972421012
Cited by: 87
References: 77
Citations by year: 2026: 1 · 2024: 3 · 2023: 3 · 2022: 7 · 2021: 4 · 2020: 6 · 2019: 3 · 2018: 2 · 2017: 2 · 2016: 6 · 2015: 8 · 2013: 2 · 2012: 5
FWCI: 3.21
Type: journal article
Language: en
Open access: closed
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: Agency for Healthcare Research and Quality (HS08362)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Keywords: radiofrequency ablation, supraventricular tachycardia, cost-effectiveness, antiarrhythmic therapy, quality-adjusted life years, quality of life, medical management
MeSH terms: Adult, Aged, Anti-Arrhythmia Agents, Cost-Benefit Analysis, Decision Trees, Direct Service Costs, Heart Block, Humans, Markov Chains, Middle Aged, Sensitivity and Specificity, Tachycardia, Supraventricular, Drug Costs, Catheter Ablation, Quality-Adjusted Life Years

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Cost-Effectiveness of Radiofrequency Ablation for Supraventricular Tachycardia

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