1. [Cost-benefit analysis of concomitant atrial fibrillation management in Spain].
- Author
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López Gude MJ, Rodríguez Bezos D, and Rodríguez Barrios JM
- Subjects
- Aged, Aged, 80 and over, Anti-Arrhythmia Agents therapeutic use, Atrial Fibrillation drug therapy, Atrial Fibrillation epidemiology, Atrial Fibrillation etiology, Atrial Fibrillation surgery, Cardiac Surgical Procedures methods, Catheter Ablation economics, Cost-Benefit Analysis, Female, Heart Valve Prosthesis economics, Humans, Male, Markov Chains, Middle Aged, Mitral Valve Insufficiency complications, Mitral Valve Insufficiency economics, Mitral Valve Insufficiency surgery, Models, Theoretical, Monte Carlo Method, National Health Programs economics, Quality-Adjusted Life Years, Spain epidemiology, Anti-Arrhythmia Agents economics, Atrial Fibrillation economics, Cardiac Surgical Procedures economics
- Abstract
Objectives: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice; this disorder is a risk factor for stroke and is associated with substantial morbidity and mortality. Our objective was to develop a cost-utility analysis of the different treatment alternatives in patients aged 40 years old or more with concomitant AF with valve disease in Spain, from the National Health System perspective., Methods: An economic evaluation through a Markov model with four health states (sinus rhythm, AF, dependent stroke, death) was developed to simulate the evolution of a cohort of 1,000 patients receiving each treatment alternative in addition to mitral valve surgery (drug therapy, surgical ablation and catheter ablation). The time horizon was 5 years, with a cycle length of 3 months. Data on costs and effects were obtained from the published literature and expert opinion and were discounted at 3.5%. A sensitivity analysis was developed to determine the robustness of the results., Results: The quality-adjusted life years (QALY) gained were 3.29, 3.89, and 3.83, respectively, for the alternatives of no ablation, surgical ablation and catheter ablation. The costs per patient were 5,770euro, 10,034euro and 11,289euro, respectively. The surgical ablation cost/QALY rate compared with no ablation was 7,145euro. Surgical ablation was dominant versus catheter ablation. The probabilistic sensitivity analysis showed that the results were robust., Conclusions: Surgical ablation is a cost-effective treatment option in patients with concomitant AF, with a cost-effectiveness ratio under the efficiency threshold commonly accepted in Spain., (Copyright 2009 SESPAS. Published by Elsevier Espana. All rights reserved.)
- Published
- 2010
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