title: Cost-effectiveness of cryoballoon ablation for the management of paroxysmal atrial fibrillation.
abstract: OBJECTIVE
  Cryoballoon ablation is an established treatment option for the management of patients with atrial fibrillation. We sought to evaluate the cost-effectiveness of cryoablation, compared with second-line anti-arrhythmic drug (AAD) therapy in patients with paroxysmal atrial fibrillation (PAF), from a UK payer perspective.
  
  
  RESULTS
  We developed a state-transition (Markov) model to calculate the total costs and quality-adjusted life-years (QALYs) associated with cryoablation and AAD therapy in patients with PAF. A 5-year horizon was used for the base-case. Data from a recent study of cryoballoon ablation in patients with PAF were used to model short-term health outcomes and costs, together with longer term external evidence to populate subsequent time periods. Total discounted costs were £21 162 and £17 627 for the cryoballoon ablation and AAD arms, respectively. Total QALYs of 3.565 and 3.404 therefore led to an incremental cost-effectiveness ratio of £21 957 per QALY gained. Sensitivity analysis suggested that the key drivers of the results were the model time horizon, the costs of follow-up care in patients with recurrent AF, and the costs of the ablation procedure.
  
  
  CONCLUSIONS
  Cryoballoon ablation provides increased quality-adjusted life expectancy compared with AAD at reasonable additional cost, representing good value for money in patients with PAF.
authors.affiliation: Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Reynolds
authors.forename: Mark
authors.initials: M
authors.lastname: Lamotte
authors.forename: Derick
authors.initials: D
authors.lastname: Todd
authors.forename: Yaariv
authors.initials: Y
authors.lastname: Khaykin
authors.forename: Simon
authors.initials: S
authors.lastname: Eggington
authors.forename: Stelios
authors.initials: S
authors.lastname: Tsintzos
authors.forename: Gunnar
authors.initials: G
authors.lastname: Klein
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000191:economics* / Q000627:therapeutic use; D000925:Anticoagulants / Q000009:adverse effects / Q000191:economics; D001281:Atrial Fibrillation / Q000150:complications / Q000191:economics* / Q000628:therapy; D003362:Cost-Benefit Analysis; D003452:Cryosurgery / Q000191:economics* / Q000379:methods; D006801:Humans; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000191:economics* / Q000209:etiology / Q000517:prevention & control; D006113:United Kingdom
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants
keywords: Atrial fibrillation; Cost-effectiveness analysis; Cryoablation; Quality of life; Stroke