Cost-Effectiveness of Radiofrequency Ablation for Supraventricular Tachycardia

  1. Carol H.F. Cheng, BS;
  2. Gillian D. Sanders, PhD;
  3. Mark A. Hlatky, MD;
  4. Paul Heidenreich, MD, MS;
  5. Kathryn M. McDonald, MM;
  6. Byron K. Lee, MD;
  7. Mary S. Larson, MD; and
  8. Douglas K. Owens, MD, MS
  1. From Stanford University, Stanford, and Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and Yale University School of Medicine, New Haven, Connecticut.

    Abstract

    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 antiarrhythmic 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.

    Article and Author Information

    • Acknowledgment: The authors thank Lyn Dupré for editorial assistance.

    • Grant Support: In part by the Cardiac Arrhythmia and Risk of Death Patient Outcome Research Team grant HS 08362 to Stanford University from the Agency for Healthcare Research and Quality, Rockville, Maryland. Drs. Owens and Heidenreich were supported by Career Development Awards from the Veterans Affairs Health Services Research and Development Service.

    • Requests for Single Reprints: Douglas K. Owens, MD, MS, Center for Primary Care and Outcomes Research, 179 Encina Commons, Stanford University, Stanford, CA 94305-6019; e-mail, owens{at}stanford.edu.

    • Current Author Addresses: Ms. Cheng: Stanford Medical Informatics, 251 Campus Drive, MSOB X-215, Stanford University, Stanford, CA 94305-5479.

    • Dr. Sanders and Ms. McDonald: Center for Primary Care and Outcomes Research, 179 Encina Commons, Stanford University, Stanford, CA 94305-6019.

    • Dr. Hlatky: Department of Health Research and Policy, HRP Building, Stanford University, Stanford, CA 94305-5405.

    • Drs. Heidenreich and Owens: Veterans Affairs Helath Care System, 3801 Miranda Avenue, Palo Alto, CA 94304.

    • Dr. Lee: 300 Pasteur Drive, Falk Cardiovascular Research Building, Stanford, CA 94305-5246.

    • Dr. Larson: Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT.

    • Author Contributions: Conception and design: G.D. Sanders, M.A. Hlatky, P. Heidenreich, K.M. McDonald, B.K. Lee, M.S. Larson, D.K. Owens.

    • Analysis and interpretation of the data: C.H.F. Cheng, G.D. Sanders, M.A. Hlatky, P. Heidenreich, K.M. McDonald, D.K. Owens.

    • Drafting of the article: C.H.F. Cheng, G.D. Sanders, D.K. Owens.

    • Critical revision of the article for important intellectual content: C.H.F. Cheng, M.A. Hlatky, P. Heidenreich, B.K. Lee, M.S. Larson, D.K. Owens.

    • Final approval of the article: C.H.F. Cheng, G.D. Sanders, M.A. Hlatky, P. Heidenreich, K.M. McDonald, B.K. Lee, M.S. Larson, D.K. Owens.

    • Provision of study materials or patients: M.A. Hlatky, M.S. Larson.

    • Statistical expertise: M.A. Hlatky, P. Heidenreich.

    • Obtaining of funding: M.A. Hlatky, K.M. McDonald.

    • Administrative, technical, or logistic support: M.A. Hlatky, P. Heidenreich, K.M. McDonald.

    • Collection and assembly of data: C.H.F. Cheng, G.D. Sanders, P. Heidenreich, K.M. McDonald.

    Summary for Patients

    • Summaries for Patients:Cost-Effectiveness of Radiofrequency Ablation for Supraventricular Tachycardia Ann Intern Med December 5, 2000 133:S57
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    1. Ann Intern Med December 5, 2000 vol. 133 no. 11 864-876
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