Cryoablation Possibly Cost Effective in Paroxysmal Atrial Fibrillation

From a US Medicare payer perspective, first-line cryoablation may be a cost-effective alternative to antiarrhythmic drugs (AADs) in symptomatic paroxysmal atrial fibrillation (PAF), according to study findings published in Heart Rhythm O².

Investigators sought to compare the cost-effectiveness of first-line cryoablation with first-line AADs for treating symptomatic PAF from a US Medicare payer perspective.

They conducted an analysis incorporating individual patient-level data from 703 participants enrolled into Cryo-FIRST (ClinicalTrials.gov Identifier: NCT01803438), STOP AF First (ClinicalTrials.gov Identifier: NCT03118518), and EARLY-AF (ClinicalTrials.gov Identifier: NCT02825979) to derive parameters for a cost-effectiveness model. Quality-adjusted life years (QALYs) were used to express health benefits.

The investigators used a 1-year time horizon hybrid decision tree and a 40-year time horizon Markov model. Costs and benefits were discounted 3% per year.

They incorporated AF recurrence and resolution, rate of AF-related hospitalization, rate of emergency department visits, rate of pharmaceutical and electrical cardioversion, rate of outpatient appointments, rate of repeat ablation, and EQ-5D-3L utility values (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) into the analysis.

Cryoablation was estimated to yield higher costs (+$4274/patient; 95% credible intervals [CrI], $391-$8126) over a 40-year time horizon and higher QALYs (+0.17; 95% CrI, 0.04-0.36) than AADs. Analysis authors stated this produced an average incremental cost-effectiveness ratio of $24,637/QALY gained (95% CrI, $4910-$132,703). Individual patients were expected to receive approximately 1.2 ablations over a lifetime, independent of initial treatment.

Compared with patients treated with AADs, those initially treated with cryoablation had a 45% relative reduction in time spent in AF health states.

Limitations of the analysis include the health state parameters being derived from electrocardiogram monitoring data, which may incorrectly estimate the rate of AF recurrence (leading to incorrectly estimating re-treatment costs), and the application of publicly available costs based on Medicare Part D drugs.

“Initial rhythm control with first-line cryoballoon ablation is highly cost-effective compared to first-line AADs from a US Medicare payer perspective,” analysis authors wrote. Specifically, they noted, “Cryoablation is estimated to be more costly than AADs whilst yielding higher QALYs over a patient’s lifetime, resulting in an average incremental cost-effectiveness ratio of $24,637 per QALY gained.”

Disclosure: This research was supported by Medtronic. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.