Heart failure & cardiomyopathies
Cost-effectiveness of catheter ablation in end-stage heart failure with atrial fibrillation: Insights from CASTLE-HTx
Authors' conclusion
The combination of catheter ablation and GDMT is cost-effective and economically favorable in patients with end-stage HF and AF who are referred for HTx evaluation.
Study context
- Population
- Patients with end-stage heart failure (HF) and atrial fibrillation (AF) referred for HTx evaluationrandomized in CASTLE-HTx
- Participants
- 194 patients
- Exposure
- catheter ablation plus guideline-directed medical therapy (GDMT) vs medical therapy alone
- catheter ablation and GDMTn = 97
- medical therapy alonen = 97
Methodological detailscohort-based Markov model, perspective of the German statutory health insurance system, using 3-year outcomes from CASTLE-HTx
- Cohort-based Markov model
- Perspective of the German statutory health insurance system
- Using 3-year outcomes from CASTLE-HTx
Main finding
As reported in the abstract
Lifetime survival gain, incremental cost and ICER per LY · lifetime
Mean survival gain per patient
∼1.7 LYs
Incremental cost
∼€12,000
Incremental cost-effectiveness ratio per LY gained
∼€7300
Observational data: associations, not effects.
Further findings
Incremental cost-effectiveness ratio per QALY
- Lifetime projections
- €8600
- At 36 months
- €30,400
- Below €50,000 per QALY, indicating cost-effectiveness at contemporary thresholds
LY gain within 36 months
- Gain
- 0.34 life-years (LYs)
- Reflecting prevention of death and worsening HF
Sensitivity analyses
- The long-term benefit emerged early and remained consistent across sensitivity analyses
Original publication
Cost-effectiveness of catheter ablation in end-stage heart failure with atrial fibrillation: Insights from CASTLE-HTx. Heart Rhythm. Published 19 May 2026. doi:10.
Summarised from the published abstract; every number is checked against it