Is Expensive New Heart Rhythm Treatment "Worth It"?

A new procedure that stops the most common form of irregular heartbeat is expensive, but it may pay off in the long run for many patients, new research suggests. That means it's important for doctors to choose carefully who receives it, and to perform further research on its long-term benefit, the authors say.

The study looks at a treatment called left atrial catheter ablation or LACA, which in the last few years has attracted tremendous attention as a new option for the 2.3 million Americans who have a heart-rhythm condition called atrial fibrillation.

LACA delivers tiny "zaps" of radiofrequency energy directly to the heart muscle to stop the electrical circuits that cause irregular heartbeats. The treatment is seen as an exciting option for atrial fibrillation, which interferes with daily life and greatly increases the risk of stroke. But like any new therapy, LACA carries costs and risks as well as benefits - and until now, no one has assessed the economics of this treatment, or compared its costs and benefits with those of drug-based treatment.

The new research, published in the Journal of the American College of Cardiology by a team from the University of Michigan Cardiovascular Center and the VA Ann Arbor Healthcare System, takes a hard look at the dollars and cents of the issue.

Using sophisticated computer modeling, the researchers tallied the cost and benefits of LACA and drugs for people of different ages and health statuses. They ran calculations based on a range of assumptions about LACA's ability to reduce stroke risk, since the procedure is still new enough that its stroke-preventing power isn't clear.

In general, the researchers found, it's far more cost-effective to provide LACA to atrial fibrillation patients who are relatively younger (around 55 years of age), and who have one or more risk factors for stroke besides atrial fibrillation, compared with keeping them on traditional drug therapy to control heart rate. The advantage isn't so clear in older patients, nor in those who don't have other risk factors such as high blood pressure, diabetes, heart failure or prior strokes.

"Before LACA is more generally adopted as a treatment option, it's important to ask from a societal perspective if it's cost effective, and under what conditions," says first author Paul Chan, M.D., M.Sc., a fellow in cardiovascular medicine at the U-M Medical School and member of the VA Health Services Research & Development Center. "This analysis provides a conservative model that could be used to assess LACA's cost-effectiveness as more is learned about the impact of LACA on stroke risk."

Adds senior author and cardiovascular medicine associate professor Hakan Oral, M.D., who is a member of a U-M team that has performed LACA on more than 2,000 atrial fibrillation patients and published extensive research on the procedure, "Through rigorous modeling with conservative estimates, this study provides the groundwork for the cost-effectiveness of catheter ablation in treatment of atrial fibrillation."