Related Experiment Video
Updated: Aug 7, 2026
Reduced Procedure Time and Variability with Active Esophageal Cooling During Radiofrequency Ablation for Atrial Fibrillation
Published on: August 25, 2022
Cost-effectiveness of radiofrequency catheter ablation for atrial fibrillation
Paul S Chan1, Sandeep Vijan, Fred Morady
1Division of Cardiology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA. paulchan@umich.edu
Insights
Left atrial catheter ablation (LACA) may be cost-effective for managing atrial fibrillation (AF) in moderate-stroke-risk patients. However, LACA is not cost-effective for low-stroke-risk individuals with AF.
Area of Science:
- Cardiology
- Health Economics
Background:
- Atrial fibrillation (AF) management often involves medication or ablation.
- The cost-effectiveness of left atrial catheter ablation (LACA) for AF remains unclear.
Purpose of the Study:
- Compare the cost-effectiveness of LACA, amiodarone, and rate control for AF.
- Evaluate LACA's economic value across different patient profiles and risk levels.
Main Methods:
- Developed a decision-analytic model for cost-effectiveness analysis.
- Utilized published literature and Medicare data for costs, utilities, and probabilities.
- Conducted threshold analyses for LACA efficacy and stroke risk reduction at $50,000 and $100,000/QALY.
Main Results:
- LACA requires significant stroke risk reduction (42% for <$50k/QALY) at 80% efficacy in 65-year-olds with moderate stroke risk.
- Younger patients (55-year-olds) with moderate stroke risk need lower efficacy or risk reduction for cost-effectiveness.
- LACA is unlikely to be cost-effective for patients with low stroke risk.
Conclusions:
- LACA shows potential cost-effectiveness for moderate-stroke-risk AF patients.
- LACA is not a cost-effective strategy for low-stroke-risk AF patients.
- Threshold analyses provide effect size estimates for future clinical trial design.
Objectives:
We sought to compare the cost-effectiveness of left atrial catheter ablation (LACA), amiodarone, and rate control therapy in the management of atrial fibrillation (AF).
Background:
Left atrial catheter ablation has been performed to eliminate AF, but its cost-effectiveness is unknown.
Methods:
We developed a decision-analytic model to evaluate the cost-effectiveness of LACA in 55- and 65-year-old cohorts with AF at moderate and low stroke risk. Costs, health utilities, and transition probabilities were derived from published literature and Medicare data. We performed primary threshold analyses to determine the minimum level of LACA efficacy and stroke risk reduction needed to make LACA cost-effective at 50,000 dollars and 100,000 dollars per quality-adjusted life-year (QALY) thresholds.
Results:
In 65-year-old subjects with AF at moderate stroke risk, relative reduction in stroke risk with an 80% LACA efficacy rate for sinus rhythm restoration would need to be > or =42% and > or =11% to yield incremental cost-effectiveness ratios (ICERs) <50,000 dollars and 100,000 dollars per QALY, respectively. Higher and lower LACA efficacy rates would require correspondingly lower and higher stroke risk reduction for equivalent ICER thresholds. In the 55-year-old moderate stroke risk cohort, lower LACA efficacy rates or stroke risk reduction would be needed for the same ICER thresholds. In patients at low stroke risk, LACA was unlikely to be cost-effective.
Conclusions:
The use of LACA may be cost-effective in patients with AF at moderate risk for stroke, but it is not cost-effective in low-risk patients. Our threshold analyses may provide a framework for the design of future clinical trials by providing effect size estimates for LACA efficacy needed.
