Cost-Effectiveness Mathematical Model to Evaluate the Impact of Improved Cardiac Ablation Strategies for Atrial Fibrillation Treatment

Abstract

Atrial fibrillation (AF) is the most common form of cardiac arrhythmia. Despite the frequency of the disease, the treatment strategies for AF are inefficient. We developed a cost-effectiveness model to evaluate potential improvements in the application of cardiac ablations to treat AF. These are surgical procedures to terminate the arrhythmia and restore Sinus Rhythm. A Markov Model with a time horizon of five years was built to represent the management of patients in AF. A Montecarlo simulation was developed as a sensitivity analysis when the effectiveness increases the estimate of the potential impact of an improvement on the efficacy of cardiac ablation. The result of the analysis showed 44% of patients were untreated in any way. The base case ends up with 45% of patients having sinus rhythm restored after five years. The Montecarlo simulation estimates that in 58% of cases, the alternative of increasing ablation effectiveness by 25% would be cost-effective. If the number of performed ablations is doubled, the robustness increases to 86%. In conclusion, the model of management of AF highlights the importance of not only increasing effectiveness, but also treating more patients. Our study shows that investing in new screening technology to increase the effectiveness of ablations would be cost-effective.

Keywords

• atrial fibrillation
• cost-effectiveness analysis
• markov model
• health economics