Objective

Catheter ablation is a commonly used therapy for symptomatic nonvalvular atrial fibrillation (AF). VISITAG SURPOINT™ (Ablation Index/AI) is a module that allows annotation and tagging of ablation applications. Ablation with AI is associated with a significant reduction in atrial arrhythmia recurrence at 12 months versus ablation with catheters alone in meta-analyses. The objective of this study was to assess the cost-effectiveness of AI for catheter ablation versus ablation with catheters alone in adult patients with drug-refractory paroxysmal or persistent AF from the German and Belgium healthcare payer’s perspectives.

Methods

A two-stage model was built, consisting of a decision tree model that simulated clinical events, costs, and utilities over one year after the ablation procedure, followed by a Markov model that extrapolated events over a lifetime horizon. Clinical events probabilities, costs, and utilities were obtained from a meta-analysis, published literature, and administrative data. Costs were adjusted to 2021 Euros. The effectiveness outcome was quality-adjusted life years (QALYs). Both deterministic and probabilistic sensitivity analyses were performed.

Results

In the base-case analyses, ablation with AI was the dominant strategy, i.e., it was associated with cost savings (−768 and -782 €/patient in Belgium and Germany respectively) and gains in QALYs (0.01 per patient in both countries). The incremental cost-effectiveness ratio was most sensitive to variations in odds ratio for freedom of AF at 12 months, baseline probability of freedom of AF at 12 months and the disutility associated with AF recurrence. In probabilistic sensitivity analyses, ablation with AI was the dominant strategy in 100% of the 1,000 simulations in both countries.

Discussion

For adult patients with drug-refractory atrial fibrillation, catheter ablation with AI dominated catheter ablation without AI. This study has policy implications favoring use of catheter ablation with AI in adult patients with drug-refractory paroxysmal or persistent AF in Belgium and Germany.