Cost-effectiveness of catheter ablation in patients with ventricular tachycardia

Background-This study evaluated the cost-effectiveness of catheter ablation therapy Versus amiodarone for treating ventricular tachycardia (VT) in pat ients with structural heart disease. The analysis used a societal perspecti ve for a hypothetical cohort of VT patients with implantable cardioverter-d efibrillators, who were experiencing frequent shocks. Methods and Results-We calculated incremental cost-effectiveness of ablatio n relative to amiodarone over 5 years after treatment initiation. Event pro babilities were from the Chilli randomized clinical trial (Chilli Cooled Ab lation System, Cardiac Pathways Corporation, Sunnyvale, Calif), the literat ure, and a consensus panel. Costs were from 1998 national Medicare reimburs ement schedules. Quality-of-life weights (utilities) were estimated using a n established preference measurement technique. In a hypothetical cohort of 10 000 patients, 5-year costs were higher for patients undergoing ablation compared with amiodarone therapy ($21 795 versus $19 075). Ablation also p roduced a greater increase in quality of life (2.78 versus 2.65 quality-adj usted life-years [QALYs]). This yielded a cost-effectiveness ratio of $20 9 23 per QALY gained for ablation compared with amiodarone. Results were rela tively insensitive to assumptions about ablation success and durability. In less severe patients with goad ejection fractions who suffer their first V T episode, the incremental cost-effectiveness ratio was $6028 per QALY gain ed. These cost-effectiveness ratios are within the range generally thought to warrant technology adoption. Conclusions-This study demonstrates that, from a societal perspective, cath eter ablation appears to be a cost-effective alernative to amiodarone for t reating VT patients.