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

Background: This 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 results: A 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 [$]). 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 $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 $355 000.

Conclusions: When 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 registration: URL: http://www.clinicaltrials.gov. Identifier: NCT01490814.

Keywords: atrial fibrillation; catheter ablation; cryoballoon; health economics; pulmonary vein isolation.

Figure 1

Healthcare cost savings: Total trial period payer costs of healthcare utilizations (HCUs) for the cryoballoon and radiofrequency current (RFC) groups calculated by multiplying the number of HCUs by the specific payer cost per HCU across 3 national healthcare systems. The cryoballoon group demonstrated a statistically significant cost reduction in all 3 systems when compared with RFC, with the largest cost reductions in repeat ablations and cardiovascular rehospitalizations. Cryo indicates cryoballoon.

Figure 2

Cost‐savings distribution: German healthcare system results of bootstrap modeling of 1000 healthcare utilization (HCU) iterations in the German healthcare system, with the y axis demonstrating the frequency of cost savings and the x axis demonstrating the amount of cost savings. As demonstrated by the distributions to the right of the dotted line, the cryoballoon (CB) group demonstrated cost savings compared with the radiofrequency current (RFC) group, with 97% and 98% probability in the all‐cause rehospitalization and cardiovascular‐only rehospitalization analyses, respectively.

Figure 3

Sensitivity analysis on payment levels: German healthcare system. One‐way sensitivity analysis after varying the payment level for the most commonly used payment codes. The blue “x” indicates the mean cost savings per patient from the analysis. The green and red arrows illustrate how the cost savings change when the individual cost input is decreased or increased by 20%, respectively. The analysis demonstrates that cost savings was most dependent on the payment for a repeat ablation and largely insensitive to changes in the individual payment levels for other types of healthcare utilization. AF indicates atrial fibrillation.