Cost-Utility Analysis of Cryoballoon Ablation versus Radiofrequency Ablation in the Treatment of Paroxysmal Atrial Fibrillation; Case Study: Iran

Background: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia at which electrical stimulation does not pass a distinct pathway through heart. There are various methods to treat AF which Ablation is one of the most effective among them. The present study aimed to assess cost utility of Cryoballoon ablation (CBA) comparing to Radiofrequency ablation (RFA) to treat patients with AF in Iran. Methods: Cost utility analysis is done using a decision analytic model based on a lifetime Markov structure which was drawn considering nature of interventions and natural progress of disease. Costs data was extracted from medical records of 47 patients of Rajaie Cardiovascular Medical and Research Center in Tehran in 2019. Parameters and variables related to strategies such as transition probabilities, risks related to side effects and mortality rates as well as utility values were extracted from domestic and foreign evidences. Due to uncertainty regarding some variables used in model, deterministic and probabilistic sensitivity analysis was also done. TreeAge pro 2020 were used in all stages of analysis. Results: In the base case analysis, CBA strategy was associated with higher cost and effectiveness rather than RFA, and the incremental cost-effectiveness ratio (ICER) was $11223 per Quality adjusted life year (QALY), which compared to Iran one time GDP per capita ($7142) as Willingness to pay threshold, CBA was not cost effective. But on the other hand, considering twice the GDP per capita as threshold, CBA was cost-effective. Probabilistic sensitivity analysis confirmed findings of base case analysis, and Monte Carlo Simulation showed that RFA was cost effective by probability of 60%. One way sensitivity analysis showed that results of study has highest sensitivity to changes of RFA cost variable. The results of sensitivity analysis showed that the cost effectiveness results were not robust and are sensitive to changes in variables changes. Conclusions: Primary results showed that CBA in treatment of AF comparing to RFA is not cost-effective in Iran considering one GDP per capita. But the sensitivity analysis results showed considerable sensitivity to changes of ablation costs variable. In general, it is not possible to conclude with certainty about the cost-effectiveness of CBA against RFA.