Cost-effectiveness of heart failure pharmacotherapy withdrawal in recovered atrial fibrillation mediated cardiomyopathy: analysis of the WITHDRAW-AF randomized clinical trial.
Kenneth K Cho, Derek P Chew, Hariharan Sugumar et al.
✦ AI-curated · Sources linked
In 30 seconds
This economic analysis of the WITHDRAW-AF randomized clinical trial compared heart failure pharmacotherapy withdrawal with continuation in carefully selected patients with recovered atrial fibrillation-mediated cardiomyopathy after ablation. During the trial, withdrawal saved $1031/patient in medication costs ($1572 vs $2604, p < 0.001). In a 5-year Markov model, projected costs were $3901 (95% CI: $3852-$3950) with withdrawal and $8446 (95% CI: $8375-$8517) with continuation. Modelled functional outcomes favoured withdrawal, while quality-adjusted life-years (QALYs) were comparable.
Key findings
- In-trial medication costs were $1031/patient lower with withdrawal ($1572 vs $2604, p < 0.001).
- Five-year projected costs were $3901 (95% CI: $3852-$3950) with withdrawal versus $8446 (95% CI: $8375-$8517) with continuation.
- Withdrawal favoured 6MWT in 61.8% of simulations (difference 29.39 m, 95% CI: 23.03-35.74) and VO2max in 68.1% (difference 4.02 ml/kg/min, 95% CI: 3.49-4.44).
- QALYs were comparable between strategies (difference 0.003, 95% CI: -0.05-0.01).
Why it matters
For selected patients whose atrial fibrillation-mediated cardiomyopathy has recovered after ablation, medication withdrawal may reduce costs without modelled loss of functional status or quality of life. The findings add an economic perspective to decisions about ongoing HFrEF pharmacotherapy, while applying only to the carefully selected population studied.
What to keep in mind
The 5-year cost and outcome estimates are projections from a Markov model, not observed long-term trial outcomes; sensitivity analyses were based on 2000 Monte Carlo simulations.