Cost‐utility analysis of radiofrequency ablation versus optimal medical therapy in managing supraventricular tachycardia among Filipinos

Abstract Background Radiofrequency ablation (RFA) is the standard of care in the management of supraventricular tachycardia (SVT). Its cost‐effectiveness in an emerging Asian country has not been studied. Objectives A cost‐utility analysis of RFA versus optimal medical therapy (OMT) among Filipinos with SVT was conducted using the public healthcare provider's perspective. Methods A simulation cohort using a lifetime Markov model was constructed using patient interviews, a review of literature, and expert consensus. Three basic health states were defined: stable, SVT recurrence, and death. The incremental cost per quality‐adjusted life year (ICER) was determined for both arms. Utilities for the entry states were derived from patient interviews using the EQ5D‐5L tool; utilities for other health states were taken from publications. Costs were assessed from the healthcare payer perspective. A sensitivity analysis was done. Results Base case analysis showed that RFA versus OMT is both highly cost‐effective at 5 years and over a lifetime. RFA at 5 years costs about PhP276,913.58 (USD5,446) versus OMT of PhP151,550.95 (USD2,981) per patient. Discounted lifetime costs were PhP280,770.32 (USD5,522) for RFA, versus PhP259,549.74 (USD5,105) for OMT. There was improved quality of life with RFA (8.1 vs. 5.7 QALYs per patient). The 5‐year and lifetime incremental cost‐effectiveness ratios were PhP148,741.40 (USD2,926) and Php15,000 (USD295), respectively. Sensitivity analysis showed 56.7% of simulations for RFA fell below a GDP‐benchmarked willingness‐to‐pay (WTP) threshold. Conclusion Despite the initial higher cost, RFA versus OMT for SVT is highly cost‐effective from the Philippine public health payer's perspective

Quinidine, a life-saving medication for Brugada syndrome, is inaccessible in many countries

The aim of this study was to determine the availability of quinidine throughout the world. Quinidine is the only oral medication that is effective for preventing life-threatening ventricular arrhythmias due to Brugada syndrome and idiopathic ventricular fibrillation. However, because of its low price and restricted indication, this medication is not marketed in many countries. We conducted a survey of the availability of quinidine by contacting professional medical societies and arrhythmia specialists worldwide. Physicians were e-mailed questionnaires requesting information concerning the quinidine preparation available at their hospital. We also requested information concerning cases of adverse arrhythmic events resulting from unavailability of quinidine. A total of 273 physicians from 131 countries provided information regarding the availability of quinidine. Quinidine was readily available in 19 countries (14%), not accessible in 99 countries (76%), and available only through specific regulatory processes that require 4 to 90 days for completion in 13 countries (10%). We were able to gather information concerning 22 patients who had serious arrhythmias probably related (10 cases) or possibility related (12 cases) to the absence of quinidine, including 2 fatalities possibly attributable to the unavailability of quinidine. The lack of accessibility of quinidine is a serious medical hazard at the global leve