Related Experiment Video
Updated: Jun 7, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Cost Effectiveness of Catheter Ablation Versus Antiarrhythmic Drugs for Atrial Fibrillation: A Systematic Review and
Luxzup Wattanasukchai1, Tunlaphat Bubphan2, Montarat Thavorncharoensap3,4
1Clinical Epidemiology Unit, Faculty of Medicine, Khon Kean University, Khon Kaen, Thailand.
Insights
Catheter ablation (CA) is a cost-effective treatment for atrial fibrillation (AF) compared to antiarrhythmic drugs, especially in high-income nations. More economic evaluations are needed for middle- and low-income countries to understand AF treatment globally.
Area of Science:
- Cardiology
- Health Economics
- Public Health
Background:
- Atrial fibrillation (AF) is a prevalent cardiac arrhythmia linked to significant morbidity and mortality.
- Current guidelines suggest antiarrhythmic drugs or catheter ablation (CA) for AF rhythm control.
- Economic evaluations of AF treatments vary by country income level.
Purpose of the Study:
- To systematically assess and compare economic evaluations (EEs) of AF rhythm-control treatments.
- To analyze the cost-effectiveness of catheter ablation (CA) versus antiarrhythmic drugs across different country income levels.
Main Methods:
- Systematic literature search of seven electronic databases until March 30, 2024.
- Inclusion of full economic evaluations comparing CA with antiarrhythmic drugs for AF rhythm control.
- Random-effects meta-analysis of incremental net benefit (INB), with quality assessment using the ECOBIAS checklist.
Main Results:
- Twenty-seven studies from nine countries were included; 25 from high-income and 2 from upper-middle-income countries.
- Catheter ablation (CA) was favored as cost-effective in 21 studies, with a pooled INB of $US23,796 in high-income countries.
- Substantial heterogeneity was observed (I² = 99.67%); INB in upper-middle-income countries was $US18,330, with wide confidence intervals.
Conclusions:
- Catheter ablation (CA) is a cost-effective rhythm-control strategy for atrial fibrillation (AF) compared to antiarrhythmic drugs, particularly in high-income countries.
- There is a lack of economic evidence for AF treatment in upper-middle-, middle-, and low-income countries.
- Further economic evaluations are essential to guide AF treatment strategies globally.
Background:
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and is associated with substantial morbidity and mortality. Current international guidelines recommend antiarrhythmic drugs or catheter ablation (CA) as rhythm-control strategies for AF. This study aimed to comprehensively assess economic evaluations (EEs) of the treatment of AF by country income level.
Methods:
Seven electronic databases were systematically searched for EE literature until March 30, 2024, with no constraints on time or language. Two independent reviewers selected the studies, extracted the data, and assessed the quality of the data. Full EEs comparing CA with antiarrhythmic drugs for rhythm-control treatment were included; surgical or rate-control treatments were excluded. The quality of the included articles was assessed using the ECOBIAS checklist. Costs were converted to purchasing power parity US dollars for 2023. A random-effects meta-analysis was applied to pool incremental net benefit (INB) based on a heterogeneity test and its degree (I2 > 25% or Cochran's Q test < 0.1). We also explored heterogeneity and potential publication bias and conducted sensitivity and subgroup analyses.
Results:
In total, 27 studies across nine countries were eligible, predominantly from high-income countries (n = 25), with a smaller subset from upper-middle-income countries (n = 2). Because of the heterogeneity among the studies, a random-effects model was selected over a fixed-effects model to pool INBs. Most studies (n = 21) favored CA as the cost-effective intervention, yielding an INB of $US23,796 (95% confidence interval [CI] 15,341-32,251) in high-income countries. However, heterogeneity was substantial (I2 = 99.67%). In upper-middle-income countries, the estimated INB was $US18,330 (95% CI - 11,900-48,526). The publication bias results showed no evidence of asymmetrical funnel plots.
Conclusion:
In this meta-analysis, CA emerged as a cost-effective rhythm-control treatment for AF when compared with antiarrhythmic drugs, particularly in high-income countries. However, economic evidence for upper-middle-income countries is lacking, and no primary evaluations were found for low-middle-income and low-income countries. Further EEs are necessary to expand the understanding of AF treatment globally.
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