# EAST-AFNET 4: vroege ritmecontrole bij AF is kosteneffectief

*geplaatst 2023-05-19 · Hartfalen · Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · doi 10.1093/europace/euad051 · https://hartvaat.nl/2023/05/19/east-afnet-4-vroege-ritmecontrole-bij-af-is-kosteneffectief/*

Kosteneffectiviteitsanalyse van EAST-AFNET 4 toonde dat vroege ritmecontrole bij AF kosteneffectief is met een gunstige kosten-per-QALY ratio. De hogere initiële kosten worden gecompenseerd door minder cardiovasculaire events op lange termijn.

## English: Cost-effectiveness of early rhythm control vs. usual care in atrial fibrillation care: an analysis based on data from the EAST-AFNET 4 trial.

This EAST-AFNET 4 economic analysis showed that early rhythm control for atrial fibrillation is cost-effective compared with usual care, with the clinical benefits translating to favorable health economic outcomes.

## Abstract (original, from the publication)

AIMS: The randomized, controlled EAST-AFNET 4 trial showed that early rhythm control (ERC) reduces the rate of a composite primary outcome (cardiovascular death, stroke, or hospitalization for worsening heart failure or acute coronary syndrome) by ∼20%. The current study examined the cost-effectiveness of ERC compared to usual care. METHODS AND RESULTS: This within-trial cost-effectiveness analysis was based on data from the German subsample of the EAST-AFNET 4 trial (n = 1664/2789 patients). Over a 6-year time horizon and from a healthcare payer's perspective, ERC was compared to usual care regarding costs (hospitalization and medication) and effects (time to primary outcome; years survived). Incremental cost-effectiveness ratios (ICERs) were calculated. Cost-effectiveness acceptability curves were constructed to visualize uncertainty. Early rhythm control was associated with higher costs [+€1924, 95% CI (-€399, €4246)], resulting in ICERs of €10 638 per additional year without a primary outcome and €22 536 per life year gained. The probability of ERC being cost-effective compared to usual care was ≥95% or ≥80% at a willingness-to-pay value of ≥€55 000 per additional year without a primary outcome or life year gained, respectively. CONCLUSION: From a German healthcare payer's perspective, health benefits of ERC may come at reasonable costs as indicated by the ICER point estimates. Taking statistical uncertainty into account, cost-effectiveness of ERC is highly probable at a willingness-to-pay value of ≥€55 000 per additional life year or year without a primary outcome. Future studies examining the cost-effectiveness of ERC in other countries, subgroups with higher benefit from rhythm control therapy, or cost-effectiveness of different modes of ERC are warranted.

Auteurs: Sophie Gottschalk, Shinwan Kany, Hans-Helmut König, Harry Jgm Crijns, Panos Vardas, A John Camm, Karl Wegscheider, Andreas Metzner, Andreas Rillig, Paulus Kirchhof, Judith Dams

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Bron: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, https://doi.org/10.1093/europace/euad051. Bijgewerkt 2026-07-03T13:29:26Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.