[Cost-benefit analysis of concomitant atrial fibrillation management in Spain]

Area of Science:

• Cardiovascular Medicine
• Health Economics
• Interventional Cardiology

Background:

• Atrial fibrillation (AF) is a prevalent arrhythmia, increasing stroke risk and mortality.
• Patients with AF and concomitant valve disease require effective treatment strategies.
• Evaluating treatment cost-effectiveness is crucial for healthcare system resource allocation.

Purpose of the Study:

• To conduct a cost-utility analysis of AF treatment alternatives in patients with valve disease in Spain.
• To compare drug therapy, surgical ablation, and catheter ablation from a national health system perspective.
• To determine the most cost-effective strategy for managing AF in this patient population.

Main Methods:

• A Markov model simulated 1,000 patients over 5 years, with states including sinus rhythm, AF, stroke, and death.
• Economic evaluation included costs and quality-adjusted life years (QALYs) for each treatment arm.
• Data sourced from literature and expert opinion, with a 3.5% discount rate and sensitivity analysis.

Main Results:

• Surgical ablation yielded 3.89 QALYs at a cost of 10,034 euro per patient.
• Catheter ablation resulted in 3.83 QALYs at 11,289 euro, while no ablation yielded 3.29 QALYs at 5,770 euro.
• Surgical ablation was dominant over catheter ablation, with a cost/QALY of 7,145 euro compared to no ablation. Results were robust.

Conclusions:

• Surgical ablation is a cost-effective treatment for patients with AF and valve disease in Spain.
• The cost-effectiveness ratio for surgical ablation falls below established thresholds.
• This analysis supports surgical ablation as a preferred therapeutic option in this clinical context.