HRS 2021: CABANA analysis points to economic case for catheter ablation


A new analysis of the CABANA (Catheter ablation versus antiarrhythmic drug therapy for atrial fibrillation) suggests that catheter ablation offers positive economic outcomes compared to drug therapy for the treatment of atrial fibrillation (AF). This is according to the findings from an economic analysis of the trial presented as a late-breaking clinical trial at the 2021 Heart Rhythm Society annual meeting (HRS 2021, 28–31 July, Boston, USA and virtual).

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.

“As clinicians, we have seen first-hand the benefits of catheter ablation for controlling irregular heartbeats—and now we also have economic evidence to support this treatment option as a viable option for our patients,” said Derek Chew and Daniel Mark (Duke Clinical Research Institute, Durham, USA) the lead authors of the CABANA trial economic analysis. “Further, in an era of rising health care costs, it is increasingly important to deliver value-based care for progressive conditions such as AF.”

The analysis was conducted using patient-level data collected prospectively during the CABANA trial. This included resource use data such as hospitalisations, procedures and emergency department visits reported from all 2,204 enrolled patients and hospital-based costs estimated from charges using department-level cost-to-charge ratios for 1,171 US patients with billing data.

Quality-of-life adjustment factors were based on utilities directly measured during the CABANA trial and cost-effectiveness was evaluated from a US healthcare perspective over a lifetime horizon.

According to the authors of the analysis, the findings highlight that, when adjusted for quality-of-life improvements, catheter ablation offers positive economic outcomes.

The estimated incremental cost per quality-adjusted life year (QALY) gained with catheter ablation is US$57,433 which is within conventionally accepted thresholds for value in the US healthcare system.

While costs with catheter ablation compared to drug therapy were significantly higher (attributed to the initial cost of ablation: mean US$26,656±SD 9123) in the first three months of follow-up, there were no significant differences in costs beyond 12 months. Patients assigned to ablation accrued an average of 12.6 life years (LYs) and 11.0 QALYs for a total cumulative cost of US$150,987 (95% CI 145,420—169,208). Whereas, patients assigned to drug therapy accrued an average of 12.5 LYs and 10.7 QALYs for a total cumulative cost of US$135,594 (95% CI 129,918 – 155,884).

The authors note that additional analyses of CABANA will be conducted to further determine cost-effectiveness for patients with heart failure and other key sub-groups.


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