Serra-Burriel, Miquel; Aebersold, Helena; Foster-Witassek, Fabienne; Coslovsky, Michael; Rodondi, Nicolas; Blum, Manuel R; Sticherling, Christian; Moschovitis, Giorgio; Beer, Jürg H; Reichlin, Tobias; Krisai, Philipp; Aeschbacher, Stefanie; Paladini, Rebecca E; Kühne, Michael; Osswald, Stefan; Conen, David; Felder, Stefan; Schwenkglenks, Matthias (2023). Real-world cost-effectiveness of pulmonary vein isolation for atrial fibrillation: a target trial approach. Value in health, 26(12), pp. 1721-1729. Elsevier 10.1016/j.jval.2023.08.008
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Serra-Burriel_ValueHealth_2023.pdf - Published Version Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND). Download (1MB) | Preview |
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1-s2.0-S1098301523031236-main.pdf - Accepted Version Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND). Download (1MB) | Preview |
OBJECTIVES
Randomized controlled trials of pulmonary vein isolation (PVI) for treating atrial fibrillation (AF) have proven the procedure's efficacy. Studies assessing its empirical cost-effectiveness outside randomized trial settings are lacking. We aimed to evaluate the effectiveness and cost-effectiveness of PVI versus medical therapy for AF.
METHODS
We followed a target trial approach using the Swiss AF cohort, a prospective observational cohort study that enrolled AF patients between 2014 and 2017. Resource utilization and cost information was collected through claims data. Quality-of-life was measured with EQ-5D-3L utilities. We estimated incremental cost-effectiveness ratios from the perspective of the Swiss statutory health insurance system.
RESULTS
Patients undergoing PVI compared to medical therapy had a 5-year overall survival advantage with a hazard ratio of 0.75 (95%CI 0.46-1.21, p=0.69), a 19.8% standard deviation improvement in quality-of-life (95%CI 15.5-22.9%, p<0.001), at an incremental cost of 29,604 (95%CI 16,354-42,855, p<0.001) Swiss Francs (CHF). The estimated incremental cost-effectiveness ratio was CHF 158,612 per quality-adjusted life-year (QALY) gained within a 5-year time horizon. Assuming similar health effects and costs over 5 additional years changed the incremental cost-effectiveness ratio to CHF 82,195 per QALY gained. Results were robust to the sensitivity analyses performed.
CONCLUSIONS
Our results show that PVI might be a cost-effective intervention within the Swiss healthcare context in a 10-year time horizon, but unlikely to be so at 5-years, if a willingness-to-pay threshold of CHF100,000 per QALY gained is assumed. Given data availability, we find target trial designs are a valuable tool for assessing the cost-effectiveness of healthcare interventions outside of RCT settings.
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