Ablation by three-dimensional electroanatomical mapping versus anti-arrhythmic drug therapy: a cost-utility analysis in the treatment of idiopathic ventricular arrhythmias

Aim: To assess the cost-utility of ablation guided by three-dimensional electroanatomical mapping (3DEAM) with antiarrhythmic drug (AAD) therapy in the management of patients with idiopathic ventricular arrhythmias (IVA) at a highly specialized cardiovascular center in Peru. Methods: A cost-utility economic evaluation was conducted in a public institution involving patients diagnosed with IVAs between 2017 and 2022. The analysis included projections adjusted according to life expectancy. Cost analysis was performed from the payer’s perspective (public health insurance) using the macro-cost estimation methodology and applying a 9.6% discount rate. Utility values were derived from the SF-36 questionnaire, facilitating the calculation of average quality-adjusted life years (QALYs) for each group. Cost-utility analysis was executed by determining the Average Cost-Utility Ratio (ACUR) and the Incremental Cost-Utility Ratio (ICUR) against the cost-effectiveness threshold set for Peru. Results: The study included 52 patients with IVAs, with 34 undergoing 3DEAM ablation and 18 receiving AAD therapy. The recurrence rate (14.7% vs. 50%, p = 0.010) and complication/adverse event rate (0% vs. 22.2%, p = 0.011) were lower in the 3DEAM ablation group. Over a four-year time horizon, 3DEAM ablation resulted in higher average costs ($7,234.81 vs. $2,136.51), average QALYs (3.30 vs. 2.98), and ACUR ($2,187.26 vs. $716.31) compared to AAD therapy. The calculated ICUR was $15,684.78, which was below the cost-effectiveness threshold for Peru. Extending the analysis to align with life expectancy projections showed that average QALYs were significantly higher in the 3DEAM group (34.25 vs. 14.83) and with a lower ACUR ($230.94 vs. $646.01) and more favorable economic outcomes. Conclusion: The 3DEAM ablation strategy can be considered cost-utility intervention for treating IVAs in our region. These results are in line with published data on cost-effectiveness of 3DEAM ablations of IVA in developed countries.