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Cost-effectiveness of ablation surgery in patients with atrial fibrillation undergoing cardiac surgery
Nathalie H van Breugel1, Elham Bidar, Brigitte A Essers
1Department of Cardiothoracic Surgery, University Hospital of Maastricht, Maastricht, The Netherlands. n.van.breugel@mumc.nl
Insights
Concomitant ablation surgery (AS) for atrial fibrillation (AF) patients is not cost-effective one year after surgery. The procedure incurs higher costs without significant improvements in quality-adjusted life years (QALYs).
Area of Science:
- Cardiovascular Surgery
- Health Economics
- Medical Technology Assessment
Background:
- Atrial fibrillation (AF) is a common arrhythmia requiring effective treatment.
- Cardiac surgery presents an opportunity for concomitant ablation surgery (AS) to treat AF.
- The cost-effectiveness of AS in AF patients undergoing cardiac surgery requires evaluation.
Purpose of the Study:
- To assess the cost-effectiveness of concomitant ablation surgery (AS) versus standard cardiac surgery in patients with atrial fibrillation (AF).
- To compare total costs and quality-adjusted life years (QALYs) between the two surgical approaches over a one-year follow-up period.
Main Methods:
- A prospective, randomized, double-blinded, multicentre trial involving 150 AF patients undergoing cardiac surgery.
- Cost analysis from a societal perspective, including medical and non-medical costs during follow-up.
- Calculation of the incremental cost-effectiveness ratio (ICER) per QALY gained.
Main Results:
- The AS group incurred significantly higher total costs (€4,724 more) compared to the regular cardiac surgery group.
- The difference in QALYs between the groups was not statistically significant (0.06).
- The incremental cost-effectiveness ratio was €73,359 per QALY, with a <50% probability of AS being more cost-effective at a €80,000 threshold.
Conclusions:
- Concomitant ablation surgery (AS) is not a cost-effective strategy for atrial fibrillation (AF) patients within one year of cardiac surgery.
- Higher costs associated with AS do not translate into significant improvements in patient outcomes (QALYs).
- Further research may be needed to evaluate long-term cost-effectiveness or alternative patient selection criteria.
Abstract:
This study was performed to assess the cost-effectiveness of concomitant ablation surgery (AS) compared to regular cardiac surgery in atrial fibrillation (AF) patients over a one-year follow-up. Cost analysis was performed from a societal perspective alongside a prospective, randomised, double-blinded, multicentre trial. One hundred and fifty patients with documented AF were randomly assigned to undergo cardiac surgery with or without AS. One hundred and thirty-two patients were included in the cost-effectiveness study. All costs (medical and non-medical) were measured during follow-up. Costs data were combined with quality adjusted life years (QALYs) to obtain the incremental costs per QALY. Total costs of the AS group were significantly higher compared to the regular cardiac surgery group [cost difference bootstrap: €4,724; 95% uncertainty interval (UI), €2,770-€6,678]. The bootstrapped difference in QALYs was not statistically significant (0.06; 95% UI: -0.024 to 0.14). The incremental cost-effectiveness ratio is €73,359 per QALY. The acceptability curve showed that, even in the case of a maximum threshold value of €80,000 per QALY gained, the probability of AS being more cost-effective than regular cardiac surgery did not reach beyond 50%. Concluding that concomitant AS in AF is not cost-effective after a one-year follow-up compared to regular cardiac surgery.
