Cost-effectiveness of radiofrequency ablation for supraventricular tachycardia

Background: Radiofrequency ablation is an established but expensive treatment option for many forms of supraventricular tachycardia. Most cases of supraventricular tachycardia are not life-threatening; the goal of therapy is therefore to improve the patient's quality of life. Objective: To compare the cost-effectiveness of radiofrequency ablation with that of medical management of supraventricular tachycardia. Design: Markov model. Data Sources: Costs were estimated from a major academic hospital and the literature, and treatment efficacy was estimated from reports from clinical studies at major medical centers. Probabilities of clinical outcomes were estimated from the literature. To account for the effect of radiofrequency ablation on quality of life, assessments by patients who had undergone the procedure were used. Target Population: Cohort of symptomatic patients who experienced 4.6 unscheduled visits per year to an emergency department or a physician's office while receiving long-term drug therapy for supraventricular tachycardia. Time Horizon: Patient lifetime. Perspective: Societal. Interventions: Initial radiofrequency ablation, long-term anti-arrhythmic drug therapy, and treatment of acute episodes of arrhythmia with antiarrhythmic drugs. Outcome Measures: Costs, quality-adjusted life-years, life-years, and marginal cost-effectiveness ratios. Results of Base-Case Analysis: Among patients who have monthly episodes of supraventricular tachycardia, radiofrequency ablation was the most effective and least expensive therapy and therefore dominated the drug therapy options. Radiofrequency ablation improved quality-adjusted life expectancy by 3.10 quality-adjusted life-years and reduced lifetime medical expenditures by $27 900 compared with long-term drug therapy. Long-term drug therapy was more effective and had lower costs than episodic drug therapy. Results of Sensitivity Analysis: The findings were highly robust over substantial variations in assumptions about the efficacy and complication rate of radiofrequency ablation, including analyses in which the complication rate was tripled and efficacy was decreased substantially. Conclusions: Radiofrequency ablation substantially improves quality of life and reduces costs when it is used to treat highly symptomatic patients. Although the benefit of radiofrequency ablation has not been studied in less symptomatic patients, a small improvement in quality of life is sufficient to give preference to radiofrequency ablation over drug therapy.