| Title |
Cost Effectiveness of Ventricular Tachycardia Ablation Versus Escalation of Antiarrhythmic Drug Therapy The VANISH Trial
|
|---|---|
| Published in |
JACC: Clinical Electrophysiology, March 2018
|
| DOI | 10.1016/j.jacep.2018.01.007 |
| Pubmed ID | |
| Authors |
Kathryn Coyle, Doug Coyle, Isabelle Nault, Ratika Parkash, Jeffrey S. Healey, Christopher J. Gray, Martin J. Gardner, Laurence D. Sterns, Vidal Essebag, Tomasz Hruczkowski, Louis Blier, George A. Wells, Anthony S.L. Tang, William G. Stevenson, John L. Sapp |
| Abstract |
This analysis uses the data from the randomized controlled trial to assess the cost effectiveness of catheter ablation (n = 132) versus escalated antiarrhythmic therapy (n = 127). For survivors of myocardial infarction with implantable cardioverter-defibrillator shocks despite antiarrhythmic drugs, the VANISH (Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease) trial demonstrated improved clinical outcomes with catheter ablation compared with more aggressive antiarrhythmic pharmacotherapy. Health care resource use and quality-of-life data were used to determine the cost effectiveness of catheter ablation. Published references were used to estimate costs (in 2015 Canadian dollars). The analysis was over 3 years, with a 5% discount rate. Adjustment was made for censoring and baseline utilities. Ablation resulted in greater quality-adjusted life-years (QALYs) than escalated drug therapy did (1.63 vs. 1.49; difference: 0.14; 95% confidence interval [CI]: -0.20 to 0.46) and higher cost ($65,126 vs. $60,269; difference: $4,857; 95% CI: -$19,757 to $27,106); with an incremental cost per QALY gained for ablation versus escalated drug therapy of $34,057 primarily due to the initial costs of ablation, which were partially offset by the costs of subsequent ablations and adverse outcomes in the escalated drug therapy arm. For patients with amiodarone-refractory ventricular tachycardia, ablation dominated escalated drug therapy, with greater QALYs (1.48 vs. 1.26; difference: 0.22; 95% CI: -0.19 to 0.59) and lower costs ($67,614 vs. $68,383; difference: -$769; 95% CI: -$35,330 to $27,092). For those with sotalol-refractory ventricular tachycardia, ablation resulted in similar QALYs (1.90 vs. 1.90; difference: -0.00; 95% CI: -0.59 to 0.62) and higher costs ($60,455 vs. $45,033; difference: $15,422; 95% CI: -$10,968 to $48,555). For the total trial population, results are suggestive that ablation is cost effective compared with escalation of drug therapy. This result was only manifest for the subgroup of patients whose qualifying arrhythmia occurred despite amiodarone. |
X Demographics
The data shown below were collected from the profiles of 27 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 7 | 26% |
| Spain | 5 | 19% |
| Australia | 2 | 7% |
| Iceland | 2 | 7% |
| Colombia | 1 | 4% |
| Unknown | 10 | 37% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 16 | 59% |
| Practitioners (doctors, other healthcare professionals) | 7 | 26% |
| Scientists | 2 | 7% |
| Science communicators (journalists, bloggers, editors) | 2 | 7% |
Mendeley readers
The data shown below were compiled from readership statistics for 47 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 47 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Ph. D. Student | 7 | 15% |
| Researcher | 4 | 9% |
| Student > Postgraduate | 4 | 9% |
| Professor | 3 | 6% |
| Student > Doctoral Student | 2 | 4% |
| Other | 7 | 15% |
| Unknown | 20 | 43% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 17 | 36% |
| Economics, Econometrics and Finance | 2 | 4% |
| Pharmacology, Toxicology and Pharmaceutical Science | 1 | 2% |
| Nursing and Health Professions | 1 | 2% |
| Physics and Astronomy | 1 | 2% |
| Other | 3 | 6% |
| Unknown | 22 | 47% |
Attention Score in Context
This research output has an Altmetric Attention Score of 26. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 10 October 2018.
All research outputs
#1,458,342
of 25,382,440 outputs
Outputs from JACC: Clinical Electrophysiology
#313
of 1,554 outputs
Outputs of similar age
#31,720
of 344,304 outputs
Outputs of similar age from JACC: Clinical Electrophysiology
#11
of 58 outputs
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So far Altmetric has tracked 1,554 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 20.9. This one has done well, scoring higher than 79% of its peers.
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