1 Department of Clinical Medicine, Health, Aarhus University2 Department of Clinical Medicine - The Department of Cardiological Medicine B, Department of Clinical Medicine, Health, Aarhus University3 Department of Medical and Health Sciences, Linköping University, Linköping, Sweden firstname.lastname@example.org Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.5 Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.6 Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Department of Medical and Health Sciences, Division of Nursing Science, Linkoping University, Linkoping, Sweden.7 The Department of Cardiological Medicine B, Faculty of Health Sciences, Aarhus University, Aarhus University8 Gentofte University Hospital, Copenhagen, Denmark.9 Heart Center Co., Tampere University Hospital, Tampere, Finland.10 Leipzig University Hospital, Leipzig, Germany.11 Lund University Hospital, Lund, Sweden.12 Rigshospitalet, Copenhagen, Denmark.13 University Hospital, Örebro, Sweden.14 Heart Center, Kuopio University Hospital, Kuopio, Finland.15 Danish Information Technology Centre for Education and Research, Aarhus, Denmark.16 Section for Anthropology and Ethnography, Faculty of Humanities, Aarhus University, Aarhus University17 Department of Clinical Medicine, Health, Aarhus University
results from a MANTRA-PAF substudy
AIM: The aim of this prospective substudy was to estimate the cost-effectiveness of treating paroxysmal atrial fibrillation (AF) with radiofrequency catheter ablation (RFA) compared with antiarrhythmic drugs (AADs) as first-line treatment. METHODS AND RESULTS: A decision-analytic Markov model, based on MANTRA-PAF (Medical Antiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation) study data, was developed to study long-term effects and costs of RFA compared with AADs as first-line treatment. Positive clinical effects were found in the overall population, a gain of an average 0.06 quality-adjusted life years (QALYs) to an incremental cost of €3033, resulting in an incremental cost-effectiveness ratio of €50 570/QALY. However, the result of the subgroup analyses showed that RFA was less costly and more effective in younger patients. This implied an incremental cost-effectiveness ratio of €3434/QALY in ≤50-year-old patients respectively €108 937/QALY in >50-year-old patients. CONCLUSION: Radiofrequency catheter ablation as first-line treatment is a cost-effective strategy for younger patients with paroxysmal AF. However, the cost-effectiveness of using RFA as first-line therapy in older patients is uncertain, and in most of these AADs should be attempted before RFA (MANTRA-PAF ClinicalTrials.gov number; NCT00133211).
Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, 2014, Vol 17, Issue 1, p. 48-55