Catheter ablation “economically attractive” compared to drug therapy for AF

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ablationCatheter ablation of atrial fibrillation (AF) was economically attractive compared with drug therapy in the CABANA (Catheter ablation versus antiarrhythmic drug therapy for atrial fibrillation) trial, investigators have reported in Circulation.

CABANA was an investigator-initiated, open-label, multicentre, randomised trial in 126 centres in 10 countries of 2,204 symptomatic patients with atrial fibrillation aged ≥65 years, or <65 years with ≥one risk factors for stroke. The catheter ablation group (n=1,108) underwent pulmonary vein isolation, and the drug therapy group (n=1,096) received standard rhythm and/or rate control drugs, according to guidelines. Findings of the study were first published in the Journal of the American Medical Association (JAMA) in 2019.

Writing in Circulation, Derek Chew (Duke University, Durham, USA) et al note that the primary results of the trial showed that catheter ablation did not significantly reduce the primary end point of death, disabling stroke, serious bleeding, or cardiac arrest compared with drug therapy by intention-to-treat, but did improve the quality of life and freedom from AF recurrence. In the heart failure subgroup, ablation improved both survival and quality of life.

Cost-effectiveness was a prespecified secondary endpoint in the trial, in in their latest publication the study investigators report the results of this analysis.

Chew et al note that costs in the first three months averaged US$20,794±SD 1,069 higher with ablation compared with drug therapy.

The cumulative within-trial five-year cost difference was US$19,245 (95% CI [confidence interval], US$11,360–US$27,170) and the lifetime mean cost difference was US$15,516 (95% CI, –US$2963 to US$35,512) higher with ablation than with drug therapy. The drug therapy arm accrued an average of 12.5 life-years (LYs) and 10.7 quality-adjusted life-years (QALYs).


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