Análisis de coste-utilidad del manejo de la fibrilación auricular concomitante en Espa？a

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 5,770€, 10,034€ and 11,289€, respectively. the surgical ablation cost/qaly rate compared with no ablation was 7,145€. 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.