NEW ORLEANS — Catheter ablation of atrial flutter is both more effective and less costly than traditional management by cardioversion plus antiarrhythmic drug therapy, Byron K. Lee, M.D., said at the annual meeting of the Heart Rhythm Society.
“From our data, we conclude that it's time to make atrial flutter ablation therapy the first-line treatment,” said Dr. Lee of the University of California, San Francisco.
An estimated 200,000 Americans per year develop new-onset atrial flutter. Catheter ablation has already been shown to reduce the need for hospitalization, improve quality of life, and decrease the occurrence of atrial fibrillation.
However, it has not universally been considered first-line therapy, particularly at smaller hospitals without an electrophysiology laboratory, he noted.
To study the incremental cost-effectiveness of catheter ablation, compared with cardioversion and antiarrhythmic drug therapy, Dr. Lee and his coinvestigators performed a Markov model decision analysis involving a hypothetical cohort of 10,000 patients with typical isthmus-dependent atrial flutter.
Into the model they plugged treatment efficacy data derived from a literature search that supported a 1-year ablation success rate of 95% and a predicted cardioversion success rate of 58% at 1 month.
Costs were estimated using Medicare 2004 reimbursement data. Key costs included roughly $9,500 for ablation, $1,200 for cardioversion, $109 per month for antiarrhythmic agents, $2,600 per hospitalization for cardioversion, and $4,700 per ablation-related adverse event, with a 3% probability of such a complication.
Ablation remained the more expensive strategy at the 1-year mark due to its greater initial costs. Between years 2 and 3 of follow-up, however, catheter ablation became the less costly approach. At that point it became less expensive and more effective than cardioversion and antiarrhythmic drugs.
The cumulative average total costs after 5 years were estimated to be $12,920 for ablation and $24,280 for cardioversion and drugs.
Ablation resulted in an average gain of 3.57 quality-adjusted life-years, compared with 2.93 for shock and drugs.
At 1 year the cost-effectiveness of catheter ablation worked out to $48,000 per quality-adjusted life year, which falls within what health economists define as cost-effective therapy, Dr. Lee said.