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Original research
Cost-effectiveness of ablation of ventricular tachycardia in ischaemic cardiomyopathy: limitations in the trial evidence base
  1. Yang Chen1,2,
  2. Manuel Gomes3,
  3. Jason V Garcia1,
  4. Ross J Hunter1,
  5. Anthony W Chow1,
  6. Mehul Dhinoja1,
  7. Richard J Schilling1,
  8. Martin Lowe1 and
  9. Pier D Lambiase1,2
  1. 1Cardiology, Barts Health NHS Trust, London, UK
  2. 2Institute of Cardiovascular Science, University College London, London, UK
  3. 3Department of Applied Health Research, University College London, London, UK
  1. Correspondence to Dr Yang Chen; ychen89{at}cantab.net

Abstract

Objective Catheter ablation is an important treatment for ventricular tachycardia (VT) that reduces the frequency of episodes of VT. We sought to evaluate the cost-effectiveness of catheter ablation versus antiarrhythmic drug (AAD) therapy.

Methods A decision-analytic Markov model was used to calculate the costs and health outcomes of catheter ablation or AAD treatment of VT for a hypothetical cohort of patients with ischaemic cardiomyopathy and an implantable cardioverter-defibrillator. The health states and input parameters of the model were informed by patient-reported health-related quality of life (HRQL) data using randomised clinical trial (RCT)-level evidence wherever possible. Costs were calculated from a 2018 UK perspective.

Results Catheter ablation versus AAD therapy had an incremental cost-effectiveness ratio (ICER) of £144 150 (€161 448) per quality-adjusted life-year gained, over a 5-year time horizon. This ICER was driven by small differences in patient-reported HRQL between AAD therapy and catheter ablation. However, only three of six RCTs had measured patient-reported HRQL, and when this was done, it was assessed infrequently. Using probabilistic sensitivity analyses, the likelihood of catheter ablation being cost-effective was only 11%, assuming a willingness-to-pay threshold of £30 000 used by the UK’s National Institute for Health and Care Excellence.

Conclusion Catheter ablation of VT is unlikely to be cost-effective compared with AAD therapy based on the current randomised trial evidence. However, better designed studies incorporating detailed and more frequent quality of life assessments are needed to provide more robust and informed cost-effectiveness analyses.

  • VT ablation
  • Markov model
  • incremental cost-effectiveness ratio
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Footnotes

  • Twitter @dryangchen

  • Contributors YC and PDL conceived the idea. YC and MG created the Markov model. JVG and YC collected cost data internally generated by MD, RJH, AWC, RJS, ML and PDL. YC collected and cleaned the RCT data. MG conducted the sensitivity analyses. The manuscript was drafted by YC and reviewed and adjusted based on suggestions from all the coauthors. All authors gave final approval and agreed to be accountable for all aspects of the work. All revisions were made by the lead author and coauthors reviewed and commented where appropriate.

  • Funding This work is supported by a UK National Institute for Health Research Academic Clinical Fellowship awarded to YC, who is the lead author of the paper.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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