Research Article

Cost-Effectiveness of Catheter Ablation for Rhythm Control of Atrial Fibrillation

Table 2

Distributions used for model parameters in probabilistic sensitivity analysis.

VariableDistribution (parameters)Mean95% C.I. based on distribution and parameters

Normal sinus rhythm (NSR) variables
Probability of remaining in normal sinus rhythm at 1 year for AADBeta ( , )0.26(0.17, 0.34)
RR of NSR at 1 year with ablationlog normal ( , s.e. = 0.18))2.93(2.09, 4.11)
Probability (annual) of AF recurrence after NSR with AADBeta ( , )0.036(0.00324, 0.00904)
Probability (annual) of AF recurrence after NSR with ablationBeta ( , )0.221(0.023, 0.053)
Disutility due to AFBeta (4.6, 95.4)0.046(0.014, 0.095)

Treatment cost variables
Annual cost of AmiodaroneFixed$433
Cost of AF ablation hospitalizationGamma (25, 282.24)$7,056($4566, $10,709)
AF ablation physician feesFixed $2534
Number of AF ablation proceduresFixed 1.27
Follow-up cost 1st year after ablationFixed $666

Perioperative ablation complication variables
Probability of stroke as complication of AF ablationBeta ( , )0.003(0.0017, 0.0046)
Probability of TIA as complication of AF ablationBeta ( , )0.002(0.0012, 0.0038)
Probability of cardiac tamponade as complication of AF ablationBeta ( , )0.008(0.0057, 0.0010)
Probability of PV stenosis as complication of AF ablationBeta ( , )0.016(0.0017, 0.0049)
Cost of stroke as complication from AF ablationGamma ( , )$14872($9624, $21243)
Cost of TIA as complication from AF ablationGamma ( , )$4296($2,781, $6137)
Cost of cardiac tamponade as complication from AF ablationGamma ( , )$5842($3781, $8345)
Cost of PV stenosis as complication from AF ablationGamma ( , )$8487($5492, $12123)

Pulmonary toxicity variables
Annual probability of pulmonary toxicityBeta (6.14, 731.86)0.008(0.003, 0.016)
Probability of death from pulmonary toxicityBeta (3, 30)0.091(0.019, 0.208)
Probability that pulmonary toxicity is irreversibleBeta (25, 75)0.25(0.171, 0.338
Cost of acute pulmonary toxicityGamma (25, 897.36)$22434 ($14518, $32044)
Annual cost of irreversible pulmonary toxicityGamma ( , )$3799 ($2459, $5427)
Utility weight for irreversible pulmonary toxicityBeta (60, 40)0.6(0.503, 0.693)

Ischemic stroke variables
Annual probability of stroke (Chads2 = 2)Beta ( , )0.04(0.031, 0.051)
Increase in risk of stroke in the presence of AFlog normal ( s.e. = 0.18))1.6(1.11, 2.30)
First year cost of ischemic strokeGamma ( , )$58159($37638, $83076)
Subsequent years of ischemic strokeGamma ( , )$6801($4401, $9715)
Utility weight for ischemic strokeBeta (91.19, 108.80)0.46(0.39, 0.53)

Anticoagulation variables
Proportion of patients on warfarinBeta (442.2, 562.8)0.44(0.408, 0.471)
Annual cost of warfarin treatment and monitoringFixed$463
Annual probability of major bleed while being on placeboBeta (15, 2579.6)0.0058(0.00324, 0.00904)
Relative risk of major bleed warfarin relative to placebolog normal ( s.e. = 0.306))0.45(0.25, 0.82)
Proportion of major bleeds that are ICHBeta (966.96, 1942.04)0.33(0.315, 0.350)
First year cost of heamorrhagic strokeGamma ( , )$61413($39743, $87723)
Cost for subsequent years of hemorrhagic strokeGamma ( , )$5255($3401, $7507)
Utility weight for hemorrhagic strokeBeta (55.38, 144.62)0.28(0.22, 0.34)