Table 2: Summary of Study Results.
| Chan et al.30 | Rodgers/McKenna31 | Reynolds et al.(2009)21 | Eckard et al.33 | Assasi/ Blackhouse et al.34 | Ollendorf et al.36 First-line) | Reynolds et al.(2014)38 | Aronsson et al.37 | ||||||||
| 55 y.o. mod risk | 65 y.o. mod risk | 65 y.o. low risk | 5-year horizon | Lifetime horizon | 5-year horizon | 20-year horizon | 60 y.o. low risk | 65 y.o. mod risk | 75 y.o. high risk | Cryoballoon | ≤50 y.o. | >50 y.o. | |||
| QALYs | |||||||||||||||
| AF Ablation | 14.26 | 11.06 | 11.40 | 11.18 | 12.14 | 3.51 | 9.46 | 3.42 | -- | 11.63 | 8.96 | 6.00 | 3.57 | -- | -- |
| Comparison | 13.95 | 10.81 | 11.21 | 10.76 | 10.77 | 3.38 | 8.68 | 3.27 | -- | 11.12 | 8.67 | 5.80 | 3.40 | -- | -- |
| Incremental | 0.31 | 0.25 | 0.19 | 0.42 | 1.37 | 0.13 | 0.78 | 0.14 | 0.51 | 0.51 | 0.30 | 0.21 | 0.17 | 0.142 | 0.035 |
| Cost | |||||||||||||||
| AF Ablation | $59,380 | $52,369 | $43,036 | £26,016 | £26,027 | $26,584 | $9,860 | $21,150 CAD | -- | $34,044 | $38,245 | $34,410 | £21,162 | -- | -- |
| Comparison | $50,509 | $39,391 | $24,540 | £15,352 | £15,367 | $19,898 | $1,640 (annual) | $12,611 CAD | -- | $20,265 | $20,332 | $17,759 | £17,627 | -- | -- |
| Incremental | $8,871 | $12,978 | $18,496 | £10,664 | £10,660 | $6,686 | $1,660 (5-year) | $8,539 CAD | $71 CAD | $13,779 | $17,913 | $16,651 | £3,535 | €488 | €3,685 |
| ICER | |||||||||||||||
| Ablation vs. Comparator | $28,700 /QALY | $51,800 /QALY | $98,900 /QALY | £25,510 /QALY | £7,780 /QALY | $51,431/ QALY | Dominant | $59,194 CAD/QALY | Dominant | $26,869 /QALY | $60,804 /QALY | $80,615 /QALY | £21,957/QALY | €3,434 /QALY | €108,937 /QALY |
| Probability of Cost- Effectiveness of AF Ablation at Willingness-to-pay Threshhold | $50,000/QALY: 40 % $100,000/QALY: 78 % | £20,000/QALY: 16.5 % £30,000/QALY: 68.6 % | N/A | N/A | $50,000 CAD /QALY: 30 % $100,000 CAD/QALY: 89 % | Multiple | £20,000/QALY: unlikely £30,000/QALY: 86 % £40,000/QALY: 97.2 % | <€50,000/QALY: ~90 % for ≤50 y.o. group. | |||||||
AF = atrial fibrillation, AAD = anti-arrhythmic drug, RC = rate control, ASA = aspirin, NSR = normal sinus rhythm, y.o. = year old, mod = modera te, CAD = Canadian dollar, ICER = incremental cost-effectiveness ratio, QALY = quality-adjusted life year