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FIRE AND ICE: Cryoballoon ablation yields favorable health economics vs. radiofrequency ablation
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In the FIRE AND ICE trial, patients with atrial fibrillation who underwent cryoballoon catheter ablation used fewer postprocedure health care resources and experienced fewer repeat ablations and reinterventions compared with patients who underwent radiofrequency ablation, demonstrating favorable health economics across three major health care systems.
For the health economic analysis, researchers analyzed payer costs across the German, U.K. and U.S. health care systems after treatment with cryoballoon ablation catheters (Arctic Front/Arctic Front Advance, Medtronic) vs. radiofrequency ablation catheters (ThermoCool/ThermoCool SF/ThermoCool SmartTouch).
“The cryoballoon technology demonstrates cost savings across multiple health systems, driven by a reduction in post-procedure rehospitalization and reinterventions due to their underlying disease state,” Karl-Heinz Kuck, MD, PhD, director of cardiology at Asklepios Klinik St. Georg in Hamburg, Germany, said in a press release. “These analyses highlight the real-world patient outcomes and health system benefits of the cryoballoon.”
Total rehospitalization and reintervention events observed during the trial (mean follow-up, 1.5 years) were assigned payer costs based on the three health care systems, according to the release. Compared with radiofrequency ablation, this translated to:
- €244,607 total savings during the trial period under the German system (P = .012);
- £139,603 total savings during the trial period under the U.K. system (P = .013); and
- $355,005 total savings during the trial period under the U.S. system with the cryoballoon when compared to the RF catheter ablation (P = .016).
In other findings, the total number of health care utilization events was 268 in the radiofrequency ablation group vs. 205 in the cryoballoon ablation group, according to the release.
The researchers also evaluated the association between baseline patient characteristics and CV hospitalizations to determine whether certain subgroups may have a more favorable response to treatment with cryoballoon or radiofrequency ablation. Patients with a CHA2DS2-VASC score of 0-1 and/or patients with prior direct current cardioversion had significantly lower risk for CV rehospitalization with cryoballoon ablation vs. radiofrequency ablation, according to the release.
The overall FIRE AND ICE trial enrolled 769 patients. The trial met its primary efficacy endpoint of noninferiority for cryoballoon ablation vs. radiofrequency ablation for the reduction of arrhythmia recurrence and need for antiarrhythmic drug therapy and/or repeat ablation.