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Cost-utility analysis of Cryoballoon ablation versus Radiofrequency ablation in the treatment of paroxysmal atrial fibrillation in Iran

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  • Ali Darvishi
  • Parham Sadeghipour
  • Alireza Darrudi
  • Rajabali Daroudi

Abstract

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia (Calkins H, et al. 2012). There are various methods to treat AF of which Ablation is one of the most effective. We aimed to assess the cost-utility of Cryoballoon ablation (CBA) compared to Radiofrequency ablation (RFA) to treat patients with paroxysmal AF in Iran. A cost-utility analysis was done using a decision-analytic model based on a lifetime Markov structure which was drawn considering the nature of interventions and the natural progress of the disease. Costs data were extracted from medical records of 47 patients of Shahid Rajaie Cardiovascular Medical Center in Tehran in 2019. Parameters and variables such as transition probabilities, risks related to side effects, mortality rates, and utility values were extracted from the available evidence. Deterministic and probabilistic sensitivity analysis was also done. TreeAge pro-2020 software was used in all stages of analysis. In the base case analysis, the CBA strategy was associated with higher cost and effectiveness than RFA, and the incremental cost-effectiveness ratio was $11,223 per Quality-adjusted life year (QALY), which compared to Iran’s GDP per capita as Willingness to pay threshold, CBA was not cost-effective. On the other hand, considering twice the GDP per capita as a threshold, CBA was cost-effective. Probabilistic sensitivity analysis confirmed the findings of base case analysis, showed that RFA was cost-effective and the probability of cost-effectiveness was 59%. One-way sensitivity analysis showed that the results of the study have the highest sensitivity to changes in the RFA cost variable. Results of sensitivity analysis showed that the cost-effectiveness results were not robust and are sensitive to changes in variables changes. Primary results showed that CBA compared to RFA is not cost-effective in the treatment of AF considering one GDP per capita. But the sensitivity analysis results showed considerable sensitivity to changes of the ablation costs variable.

Suggested Citation

  • Ali Darvishi & Parham Sadeghipour & Alireza Darrudi & Rajabali Daroudi, 2022. "Cost-utility analysis of Cryoballoon ablation versus Radiofrequency ablation in the treatment of paroxysmal atrial fibrillation in Iran," PLOS ONE, Public Library of Science, vol. 17(7), pages 1-14, July.
    • Handle: RePEc:plo:pone00:0270642
    DOI: 10.1371/journal.pone.0270642
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    1. Junxia Xu & Yingqun Huang & Hongbin Cai & Yue Qi & Nan Jia & Weifeng Shen & Jinxiu Lin & Feng Peng & Wenquan Niu, 2014. "Is Cryoballoon Ablation Preferable to Radiofrequency Ablation for Treatment of Atrial Fibrillation by Pulmonary Vein Isolation? A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(2), pages 1-9, February.
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