Cost-effectiveness of catheter ablation in patients with ventricular tachycardia

Hugh Calkins, J. Thomas Bigger, Stacey J. Ackerman, Steven B. Duff, David Wilber, Robert A. Kerr, Miriam Bar-Din, Kathleen M. Beusterien, Michael J. Strauss

Research output: Contribution to journalArticle

Abstract

Background - This study evaluated the cost-effectiveness of catheter ablation therapy versus amiodarone for treating ventricular tachycardia (VT) in patients with structural heart disease. The analysis used a societal perspective for a hypothetical cohort of VT patients with implantable cardioverter-defibrillators, who were experiencing frequent shocks. Methods and Results - We calculated incremental cost-effectiveness of ablation relative to amiodarone over 5 years after treatment initiation. Event probabilities were from the Chilli randomized clinical trial (Chilli Cooled Ablation System, Cardiac Pathways Corporation, Sunnyvale, Calif), the literature, and a consensus panel. Costs were from 1998 national Medicare reimbursement schedules. Quality-of-life weights (utilities) were estimated using an established preference measurement technique. In a hypothetical cohort of 10 000 patients, 5-year costs were higher for patients undergoing ablation compared with amiodarone therapy ($21 795 versus $19 075). Ablation also produced a greater increase in quality of life (2.78 versus 2.65 quality-adjusted life-years [QALYs]). This yielded a cost-effectiveness ratio of $20 923 per QALY gained for ablation compared with amiodarone. Results were relatively insensitive to assumptions about ablation success and durability. In less severe patients with good ejection fractions who suffer their first VT episode, the incremental cost-effectiveness ratio was $6028 per QALY gained. These cost-effectiveness ratios are within the range generally thought to warrant technology adoption. Conclusions - This study demonstrates that, from a societal perspective, catheter ablation appears to be a cost-effective alternative to amiodarone for treating VT patients.

Original languageEnglish (US)
Pages (from-to)280-288
Number of pages9
JournalCirculation
Volume101
Issue number3
StatePublished - Jan 25 2000

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Catheter Ablation
Ventricular Tachycardia
Amiodarone
Cost-Benefit Analysis
Quality-Adjusted Life Years
Costs and Cost Analysis
Quality of Life
Implantable Defibrillators
Medicare
Heart Diseases
Shock
Appointments and Schedules
Therapeutics
Randomized Controlled Trials
Technology
Weights and Measures

Keywords

  • Catheter ablation
  • Cost-benefit analysis
  • Tachyarrhythmias
  • Tachycardia

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Calkins, H., Bigger, J. T., Ackerman, S. J., Duff, S. B., Wilber, D., Kerr, R. A., ... Strauss, M. J. (2000). Cost-effectiveness of catheter ablation in patients with ventricular tachycardia. Circulation, 101(3), 280-288.

Cost-effectiveness of catheter ablation in patients with ventricular tachycardia. / Calkins, Hugh; Bigger, J. Thomas; Ackerman, Stacey J.; Duff, Steven B.; Wilber, David; Kerr, Robert A.; Bar-Din, Miriam; Beusterien, Kathleen M.; Strauss, Michael J.

In: Circulation, Vol. 101, No. 3, 25.01.2000, p. 280-288.

Research output: Contribution to journalArticle

Calkins, H, Bigger, JT, Ackerman, SJ, Duff, SB, Wilber, D, Kerr, RA, Bar-Din, M, Beusterien, KM & Strauss, MJ 2000, 'Cost-effectiveness of catheter ablation in patients with ventricular tachycardia', Circulation, vol. 101, no. 3, pp. 280-288.
Calkins H, Bigger JT, Ackerman SJ, Duff SB, Wilber D, Kerr RA et al. Cost-effectiveness of catheter ablation in patients with ventricular tachycardia. Circulation. 2000 Jan 25;101(3):280-288.
Calkins, Hugh ; Bigger, J. Thomas ; Ackerman, Stacey J. ; Duff, Steven B. ; Wilber, David ; Kerr, Robert A. ; Bar-Din, Miriam ; Beusterien, Kathleen M. ; Strauss, Michael J. / Cost-effectiveness of catheter ablation in patients with ventricular tachycardia. In: Circulation. 2000 ; Vol. 101, No. 3. pp. 280-288.
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