Journal Article

A danish healthcare-focused economic evaluation of first-line cryoballoon ablation versus antiarrhythmic drug therapy for the treatment of paroxysmal atrial fibrillation

Hansen, Morten Lock, Kuniss, Malte, Bromilow, Tom, Chierchia, Gian Battista, Wazni, Oussama, Johansen, Mette Lundsby, Lane, Emily, Andrade, Jason, Afonso, Daniela, Ismyrloglou, Eleni, Tønnesen, Jacob, Mealing, Stuart, Moss, Joe W. E., Sale, Alicia

2024

Overview

Introduction Three randomised controlled trials (RCTs) have demonstrated that first-line cryoballoon pulmonary vein isolation decreases atrial tachycardia in patients with symptomatic paroxysmal atrial fibrillation (PAF) compared with antiarrhythmic drugs (AADs). The aim of this study was to develop a cost-effectiveness model (CEM) for first-line cryoablation compared with first-line AADs for the treatment of PAF. The model used a Danish healthcare perspective. Methods Individual patient-level data from the Cryo-FIRST, STOP AF and EARLY-AF RCTs were used to parameterise the CEM. The model structure consisted of a hybrid decision tree (one-year time horizon) and a Markov model (40-year time horizon, with a three-month cycle length). Health-related quality of life was expressed in quality-adjusted life years (QALYs). Costs and benefits were discounted at 3% per year. Model outcomes were produced using probabilistic sensitivity analysis. Results First-line cryoablation is dominant, meaning it results in lower costs (-€2,663) and more QALYs (0.18) when compared to first-line AADs. First-line cryoablation also has a 99.96% probability of being cost-effective, at a cost-effectiveness threshold of €23,200 per QALY gained. Regardless of initial treatment, patients were expected to receive ∼ 1.2 ablation procedures over a lifetime horizon. Conclusion First-line cryoablation is both more effective and less costly (i.e. dominant), when compared with AADs for patients with symptomatic PAF in a Danish healthcare system.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Ablation / Ablation (Surgery) / Aged / Analysis / Angiology / Anti-Arrhythmia Agents - economics / Anti-Arrhythmia Agents - therapeutic use / Anti-arrhythmia drugs / Antiarrhythmic drugs / Arrhythmia / Atrial fibrillation / Atrial Fibrillation - diagnosis / Atrial Fibrillation - drug therapy / Atrial Fibrillation - economics / Atrial Fibrillation - physiopathology / Atrial Fibrillation - surgery / Atrial Fibrillation - therapy / Blood Transfusion Medicine / Cardiac arrhythmia / Cardiac Surgery / Cardiology / Care and treatment / Clinical trials / Cost Savings / Cost-Benefit Analysis / Cost-effectiveness / Costs / Cryoablation / Cryosurgery - adverse effects / Cryosurgery - economics / Decision Support Techniques / Decision Trees / Denmark / Diagnosis / Dosage and administration / Drug Costs / Drug therapy / Economic aspects / Economic models / Electrocardiography / Estimates / Female / Fibrillation / Foreign exchange rates / Health care / Humans / Internal Medicine / Male / Markov Chains / Markov processes / Medicine / Medicine & Public Health / Middle Aged / Models, Economic / Patient outcomes / Patients / Pulmonary Veins - physiopathology / Pulmonary Veins - surgery / Quality of Life / Quality-Adjusted Life Years / Randomized Controlled Trials as Topic / Sensitivity analysis / Tachycardia / Time Factors / Treatment Outcome