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. 2024 May;8(3):417-429.
doi: 10.1007/s41669-023-00471-6. Epub 2024 Jan 20.

An Economic Evaluation of a Streamlined Day-Case Atrial Fibrillation Ablation Protocol and Conventional Cryoballoon Ablation versus Antiarrhythmic Drugs in a UK Paroxysmal Atrial Fibrillation Population

Joe W E Moss  1 , Derick Todd  2 , Lukasz Grodzicki  3 , Beatrice Palazzolo  3 , Richard Mattock  4 , Stuart Mealing  3 , Maxim Souter  5 , Benedict Brown  6 , Tom Bromilow  3 , Damian Lewis  3 , James McCready  7 , Muzahir Tayebjee  8 , Ewen Shepherd  9 , Thiagarajah Sasikaran  10 , Clare Coyle  11   12 , Eleni Ismyrloglou  13 , Nicholas A Johnson  10 , Prapa Kanagaratnam  11   12
Affiliations

An Economic Evaluation of a Streamlined Day-Case Atrial Fibrillation Ablation Protocol and Conventional Cryoballoon Ablation versus Antiarrhythmic Drugs in a UK Paroxysmal Atrial Fibrillation Population

Joe W E Moss et al. Pharmacoecon Open. 2024 May.

Abstract

Background and aims: Symptom control for atrial fibrillation can be achieved by catheter ablation or drug therapy. We assessed the cost effectiveness of a novel streamlined atrial fibrillation cryoballoon ablation protocol (AVATAR) compared with optimised antiarrhythmic drug (AAD) therapy and a conventional catheter ablation protocol, from a UK National Health Service (NHS) perspective.

Methods: Data from the AVATAR study were assessed to determine the cost effectiveness of the three protocols in a two-step process. In the first stage, statistical analysis of clinical efficacy outcomes was conducted considering either a three-way comparison (AVATAR vs. conventional ablation vs. optimised AAD therapies) or a two-way comparison (pooled ablation protocol data vs. optimised AAD therapies). In the second stage, models assessed the cost effectiveness of the protocols. Costs and some of the clinical inputs in the models were derived from within-trial cost analysis and published literature. The remaining inputs were derived from clinical experts.

Results: No significant differences between the ablation protocols were found for any of the clinical outcomes used in the model. Results of a within-trial cost analysis show that AVATAR is cost-saving (£1279 per patient) compared with the conventional ablation protocol. When compared with optimised AAD therapies, AVATAR (pooled conventional and AVATAR ablation protocols efficacy) was found to be more costly while offering improved clinical benefits. Over a lifetime time horizon, the incremental cost-effectiveness ratio of AVATAR was estimated as £21,046 per quality-adjusted life-year gained (95% credible interval £7086-£71,718).

Conclusions: The AVATAR streamlined protocol is likely to be a cost-effective option versus both conventional ablation and optimised AAD therapy in the UK NHS healthcare setting.

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Conflict of interest statement

Joe Moss, Lukasz Grodzicki, Beatrice Palazzolo, Richard Mattock, Stuart Mealing, Tom Bromilow, and Damian Lewis were employees of York Health Economics Consortium (YHEC) at the time of this study. YHEC received payment from Medtronic, manufacturer of the Arctic Front Advance Cryoballoon, to conduct the cost-effectiveness analyses and to write the manuscript. Derick Todd and Prapa Kanagaratnam have received personal speaking fees from Medtronic in the past. Maxim Souter, Benedict Brown and Eleni Ismyrloglou were employees of Medtronic at the time of this study. Benedict Brown and Eleni Ismyrloglou also declare holding stock and stock options in Medtronic. James McCready has received personal speaking and consulting fees from Medtronic in the past. Muzahir Tayebjee has previously received a research grant from Medtronic. Ewen Shepherd has previously received honoraria for lectures from Medtronic. Thiagarajah Sasikaran, Clare Coyle and Nicholas A. Johnson have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Schematic of the economic model. (a) Decision tree covering the first 12 months of the economic model. The AAD decision nodes are identical to those presented for AVATAR-AF. (b) Markov model where decision tree endpoints constitute initial allocation. The Markov model covers the remaining lifetime of the economic model. Death is an absorbing state and movement into it is permissible from all other health states. The numbers at the end of each health state indicate the total number of ablations (post initial treatment) in each health state. Patients could have up to a maximum of three total ablations (including the initial procedure). Stroke, heart failure and other adverse events are not modelled as health states but rather as events that can occur to individuals within the health states, and therefore have not been included in the model schematic. AF atrial fibrillation, AAD antiarrhythmic drug, NSR normal sinus rhythm, ST short-term, LT long-term
Fig. 2
Fig. 2
Cost-effectiveness plane. The majority of outputs of the PSA iterations is below the £30,000 per QALY gained threshold. PSA probabilistic sensitivity analysis, QALY quality-adjusted life-year
See this image and copyright information in PMC

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