Key result
AVATAR streamlined day-case ablation proves cost-effective vs AADs at ~£21,000 per QALY gained.
Why the study?
Symptom control for atrial fibrillation can be achieved by catheter ablation or drug therapy, but the cost-effectiveness of a novel streamlined cryoballoon ablation protocol compared with conventional ablation and antiarrhythmic drugs needed assessment.
Does a streamlined day-case atrial fibrillation cryoballoon ablation protocol improve cost-effectiveness compared to conventional ablation or antiarrhythmic drugs in patients with paroxysmal atrial fibrillation?
Does a streamlined day-case atrial fibrillation cryoballoon ablation protocol improve cost-effectiveness compared to conventional ablation or antiarrhythmic drugs in patients with paroxysmal atrial fibrillation?
Effect estimate: ICER £21,046 per QALY gained (95% CI 7086-71718)
A streamlined day-case cryoballoon ablation protocol for paroxysmal AF is cost-saving compared to conventional ablation and cost-effective compared to antiarrhythmic drugs in the UK NHS.
Supports streamlined day-case ablation consideration in paroxysmal AF; leaves open practice change pending higher-level confirmation.
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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Moss et al. (2024) studied Paroxysmal Atrial Fibrillation (n=321). Streamlined day-case atrial fibrillation cryoballoon ablation protocol (AVATAR) vs. Conventional cryoballoon ablation protocol and optimized antiarrhythmic drug (AAD) therapy was evaluated on Incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained (ICER £21,046 per QALY gained, 95% CI 7086-71718). The AVATAR streamlined day-case ablation protocol was cost-effective compared to optimized antiarrhythmic drugs, with an incremental cost-effectiveness ratio of £21,046 per QALY gained over a lifetime horizon.
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