The Impact of Cryoballoon Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation on Healthcare Utilization and Costs: An Economic Analysis From the FIRE AND ICE Trial

Abstract

BackgroundThis study sought to assess payer costs following cryoballoon or radiofrequency current (RFC) catheter ablation of paroxysmal atrial fibrillation in the randomized FIRE AND ICE trial.Methods and ResultsA trial period analysis of healthcare costs evaluated the impact of ablation modality (cryoballoon versus RFC) on differences in resource use and associated payer costs. Analyses were based on repeat interventions, rehospitalizations, and cardioversions during the trial, with unit costs based on 3 national healthcare systems (Germany [€], the United Kingdom [£], and the United States [normal$]). Total payer costs were calculated by applying standard unit costs to hospital stays, using International Classification of Diseases, 10th Revision diagnoses and procedure codes that were mapped to country‐specific diagnosis‐related groups. Patients (N=750) randomized 1:1 to cryoballoon (n=374) or RFC (n=376) ablation were followed for a mean of 1.5 years. Resource use was lower in the cryoballoon than the RFC group (205 hospitalizations and/or interventions in 122 patients versus 268 events in 154 patients). The cost differences per patient in mean total payer costs during follow‐up were €640, £364, and normal$925 in favor of cryoballoon ablation (P=0.012, 0.013, and 0.016, respectively). This resulted in trial period total cost savings of €245 000, £140 000, and normal$355 000.ConclusionsWhen compared with RFC ablation, cryoballoon ablation was associated with a reduction in resource use and payer costs. In all 3 national healthcare systems analyzed, this reduction resulted in substantial trial period cost savings, primarily attributable to fewer repeat ablations and a reduction in cardiovascular rehospitalizations with cryoballoon ablation.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Identifier: NCT01490814.

Radiofrequency Catheter Ablation Versus Cryoballoon Ablation in the Treatment of Paroxysmal Atrial Fibrillation: A Cost-effectiveness Analysis in China

“…However, another study that used a trial-based economic analysis demonstrated that CB ablation was more cost-effective compared with RFCA. 13 Four major differences between the 2 analyses may have led to different results. First,~75% of patients in the RFCA group in the trial-based economic analysis underwent RFCA without an ST catheter, whereas an ST catheter was used in 100% of patients undergoing RFCA in our study; CBG-2 was used in 100% of patients in the CB ablation group of the trial-based analysis, whereas~72% of patients in our study underwent CB ablation with CBG-1.…”

“…However, some studies have raised questions about the cost-effectiveness of both therapies in clinical practice. 12,13 Whether one ablation approach is more cost-effective than the other, especially in the long term, is yet to be determined.…”

Pulmonary Vein Anatomy is Associated with Cryo Kinetics during Cryoballoon Ablation for Atrial Fibrillation

“…CB ablation has an increasing clinical application worldwide, it has been proved a comparable technique to radiofrequency (RF) ablation in safety and efficacy for the AF treatment, 1 and maybe more cost-effective. 2 By achieving appropriate occlusion in targeted PVs with the balloon and getting good balloon - PV ostium contact, it can simplify the procedure with a “single-shot” approach to get circumferential PV isolation. 3 It is reported that some parameters of cryo kinetics, such as balloon temperature, 4 balloon warming time, 5 can predict acute PV isolation or late PVs reconnection.…”

Incomplete endothelialization of WatchmanTM Device: Predictors and Implications from Two Cases

“…CB2 ablation is a shorter procedure compared to RF [9,11] . In an economic analysis of the FIRE AND ICE trial by Chun et al, CB2 ablation was even associated with a reduction in resource use and costs [12] . PV can have anatomical variants and this can determine a difficulty for CB2 ablation, but regardless of anatomy, PVI by CB2 has shown similar results compared to RF in patients with unusual anatomic features [13] .…”