Cost-benefit analysis of medical vs surgical treatment of symptomatic patients with accessory atrioventricular pathways.

Surgical treatment of patients with an accessory atrioventricular pathway leading to symptomatic arrhythmias provides effective control. However, surgical treatment is usually considered only when medical treatment fails. To assess the cost-benefit ratio of medical vs surgical treatment 77 patients treated with antiarrhythmic drugs were compared with 50 patients treated surgically. Cost was calculated by considering current costs for drugs, surgery and pacemakers, electrophysiological investigations, outpatient clinic controls, and costs of readmissions because of tachycardia. Mean cost per treated patient and mean cost per successfully treated patient (total cost divided by the number of patient not requiring readmission during follow-up) was respectively 4242 and 6949 US dollars after 56 months for the medically treated group and 10800 and 11250 US dollars for the surgically treated group. A projection of costs demonstrated that costs of medical treatment was the same as costs of surgical treatment after 12.5 years of treatment but a higher number of medically treated patients remain symptomatic. We conclude that surgical treatment of symptomatic patients with accessory pathways has a better cost-benefit ratio than medical treatment and should be considered earlier without waiting for failure for medical treatment.