Heart failure & cardiomyopathiesCohort study
Cost-effectiveness of catheter ablation in end-stage heart failure with atrial fibrillation: Insights from CASTLE-HTx
- cost-effectiveness analysis
- cohort-based Markov model
- perspective of the German statutory health insurance system
- using 3-year outcomes 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
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:10.1016/j.hrthm.2026.05.024
Summarised from the published abstract; every number is checked against it