Heart rhythm
May 19, 2026 · via Europe PMC
Cost-effectiveness of catheter ablation in end-stage heart failure with atrial fibrillation: Insights from CASTLE-HTx.
Boettger P, Moersdorf M, Sommer P, +18 more, CASTLE HTx Investigators.
AI summary — for doctors, generated from the abstract only
An economic analysis found that adding catheter ablation to standard medical therapy for atrial fibrillation in patients with end-stage heart failure being evaluated for heart transplant was cost-effective, providing meaningful survival gains at a cost well within accepted healthcare value thresholds.
What was studied
A cost-effectiveness analysis based on the CASTLE-HTx trial, which had shown that catheter ablation plus guideline-directed medical therapy reduced a composite of death, need for a ventricular assist device, or heart transplant compared with medical therapy alone in 194 patients with end-stage heart failure and atrial fibrillation; this analysis used a Markov model to project lifetime costs, life-years, and quality-adjusted life-years from the German health insurance system's perspective.
Key findings
- In lifetime projections, combining atrial fibrillation ablation with standard medical therapy was associated with a mean survival gain of approximately 1.7 life-years per patient at an incremental cost of about €12,000, yielding a cost of approximately €7,300 per life-year gained.
- The incremental cost-effectiveness ratios per quality-adjusted life-year were €8,600 in lifetime projections and €30,400 at 36 months, both well below the commonly used €50,000 threshold, indicating cost-effectiveness.
- Within the initial 36-month trial period, the survival benefit translated to a gain of 0.34 life-years, reflecting prevention of death and worsening heart failure, with this long-term benefit emerging early and remaining consistent across various sensitivity analyses.
Clinical relevance
These findings support that adding catheter ablation to standard medical therapy is not only clinically beneficial but also economically favorable for patients with end-stage heart failure and atrial fibrillation who are being considered for heart transplant, which could support broader adoption and reimbursement of this combined treatment approach in this very high-risk population.
Who should care
Limitations
This is a model-based economic analysis using projections from a trial with 3-year follow-up data, extrapolated to lifetime estimates, which carries inherent uncertainty; findings are based on the German healthcare system's cost perspective and may not directly translate to other healthcare systems with different cost structures.
Adding a catheter-based procedure to treat irregular heart rhythm alongside standard medication for patients with severe heart failure awaiting possible transplant evaluation was shown to be a cost-effective use of healthcare resources, extending life at a reasonable cost.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
The CASTLE-HTx (Catheter Ablation for Atrial Fibrillation in patientS With End-sTage Heart Failure and Eligibility for Heart Transplantation; ClinicalTrials.gov identifier NCT04649801) trial showed that the combination of catheter ablation and guideline-directed medical therapy (GDMT) was associated with a lower likelihood of a composite of death from any cause, implantation of a left ventricular assist device, or heart transplantation (HTx) in patients with end-stage heart failure (HF) and atrial fibrillation (AF).
Objective
This analysis evaluates the cost-effectiveness of catheter ablation plus GDMT vs medical therapy alone in patients with end-stage HF and AF referred for HTx evaluation.
Methods
In CASTLE-HTx, we randomized 194 patients in end-stage HF and AF to receive catheter ablation and GDMT (n = 97) or medical therapy alone (n = 97). Details of study design, outcome definitions, and results have been published. A cohort-based Markov model projected lifetime costs, life-years (LYs), and quality-adjusted life-years (QALYs) from the perspective of the German statutory health insurance system using 3-year outcomes from CASTLE-HTx.
Results
In lifetime projections, the combination of AF ablation and GDMT was associated with a mean survival gain of ∼1.7 LYs per patient at an incremental cost of ∼€12,000, yielding an incremental cost-effectiveness ratio of ∼€7300 per LY gained. The incremental cost-effectiveness ratios per QALY in lifetime projections (€8600) and at 36 months (€30,400) were below €50,000 per QALY, indicating cost-effectiveness at contemporary thresholds. Within 36 months, this survival benefit resulted in a gain of 0.34 LYs, reflecting prevention of death and worsening HF. The long-term benefit emerged early and remained consistent across sensitivity analyses.
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.
DOI
10.1016/j.hrthm.2026.05.024
PMID
42162774
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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