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
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 [euro], the United Kingdom [ pound], and the United States []).Totalpayercostswerecalculatedbyapplyingstandardunitcoststohospitalstays,usingInternationalClassificationofDiseases,10thRevisiondiagnosesandprocedurecodesthatweremappedtocountry−specificdiagnosis−relatedgroups.Patients(N=750)randomized1:1tocryoballoon(n=374)orRFC(n=376)ablationwerefollowedforameanof1.5years.ResourceusewaslowerinthecryoballoonthantheRFCgroup(205hospitalizationsand/orinterventionsin122patientsversus268eventsin154patients).Thecostdifferencesperpatientinmeantotalpayercostsduringfollow−upwereeuro640,pound364,and925 in favor of cryoballoon ablation (P=0.012, 0.013, and 0.016, respectively). This resulted in trial period total cost savings of euro245 000, pound140 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