Heart Rhythm Society

Heart Rhythm Society

Source:

Chew DS, et al. LBCT03-03. Presented at: Heart Rhythm 2021; July 28-31, 2021 (hybrid meeting).

Disclosures: CABANA was funded by Biosense Webster, Boston Scientific, Medtronic, the NIH and St. Jude Medical. Chew reports he receives salary support outside this work from the Canadian Institutes of Health Research Banting Fellowship program.
August 02, 2021
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CABANA: Catheter ablation appears to be cost-effective in patients with AF

Source:

Chew DS, et al. LBCT03-03. Presented at: Heart Rhythm 2021; July 28-31, 2021 (hybrid meeting).

Disclosures: CABANA was funded by Biosense Webster, Boston Scientific, Medtronic, the NIH and St. Jude Medical. Chew reports he receives salary support outside this work from the Canadian Institutes of Health Research Banting Fellowship program.
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An economic analysis indicates catheter ablation is cost-effective for patients with atrial fibrillation, especially for those who also have HF, according to new data from the CABANA trial.

As Healio previously reported, in the main results of the CABANA trial of 2,204 patients, in the intention-to-treat population, catheter ablation was not associated with improved clinical outcomes compared with medical therapy, but in on-treatment and per-protocol analyses, it was. Many patients crossed over from one treatment to the other during the study. Catheter ablation was associated with improvements in quality of life, AF burden and freedom from AF recurrence.

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“Given the upfront costs of ablation relative to drug therapy, we wanted to understand the ‘value’ of ablation,” presenter Derek S. Chew, MD, MSci, research fellow at Duke Clinical Research Institute and cardiologist at the University of Calgary, Alberta, Canada, told Healio. “This is important given the ongoing debates in U.S. health care reform, where therapeutic strategies not only required that they produce significant clinical benefits, such as reduction in clinical events or improvements in quality of life, but that they are also cost-effective. In other words, we wanted to understand the relative efficiency of ablation compared to drug therapy in producing clinical benefits according to conventional societal benchmarks of good value for money in health care.”

The researchers obtained patient costs from prospectively collected medical bills from U.S. patients; used costs predicted from multivariable models for non-U.S. patients; included medication and outpatient costs; included physician costs using Medicare fee schedule mapped to case report data; and modeled events over a lifetime horizon, Chew said during a press conference. Costs were expressed in 2018 U.S. dollars. The results from the intention-to-treat analysis were used, Chew told Healio.

For the ablation group, lifetime costs were $150,987 and quality-adjusted life-years were 11.01, whereas for the medical therapy group, lifetime costs were $135,594 and QALYs were 10.74, Chew said during the press conference.

The incremental cost-effectiveness ratio (ICER) for ablation was $57,433 per QALY gained, which is below the threshold of $100,000 commonly used in the U.S., Chew said during the press conference.

In 5,000 bootstrap simulations, 75% of them had an ICER of less than $100,000 per QALY gained, he said.

“This result is attributed primarily to substantial gains in quality of life, as we did not find a meaningful reduction in health care costs to offset the cost of the initial ablation procedure, and by intention-to-treat analysis there were not significant gains in life expectancy with ablation,” Chew told Healio.

In a subgroup analysis of 778 patients from the cohort with HF (NYHA class II or worse at baseline), the ICER for catheter ablation was $54,321 per QALY gained, and in 5,000 bootstrap simulations, 85% of them had an ICER of less than $100,000 per QALY gained, according to the researchers.

Unlike with the overall cohort, “the cost-effectiveness in this subgroup was driven by both gains in life expectancy and quality of life,” Chew told Healio.