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FIRE AND ICE: Cryoballoon ablation reduces resource use, cost
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Pulmonary vein isolation using cryoballoon ablation was linked to reduced resource use, as well as payer cost, compared with radiofrequency current catheter ablation, according to an economic analysis of the FIRE AND ICE trial.
“Atrial fibrillation is a common and chronic cardiac arrhythmia that is a burden to patients and the health care system, with an estimated annual cost of 660 million [euros] to the German health care system, 1% of the National Health Service budget in the United Kingdom and $6 billion in the U.S. health care system,” K.R. Julian Chun, MD, from the Cardioangiologisches Centrum Bethanien in Frankfurt, Germany, and colleagues wrote. “The implications on daily clinical practice and health care costs should be an important consideration for the optimization of patient outcomes with maximum efficiency given the imperative for improving value-based health care.”
Chun and colleagues conducted an economic analysis for the trial period from a payer perspective after cryoballoon or radiofrequency current catheter ablation of paroxysmal AF in the controlled, prospective, randomized, noninferiority, masked-outcomes, parallel-group FIRE AND ICE trial.
Analyses on ablation modality impact on resource use and associated payer cost were based on repeat interventions, rehospitalizations and cardioversions during the trial.
Using diagnoses from ICD-10 and procedure codes mapped to country-specific diagnosis-related groups, the researchers calculated total payer cost by applying standard unit costs to hospital stays.
A total of 750 patients who were randomly assigned to cryoballoon or radiofrequency current were followed for a mean of 1.5 years.
According to the results, there was a lower rate of resource use for those randomly assigned to the cryoballoon group (205 hospitalizations and/or interventions in 122 patients) vs. the radiofrequency current cohort (268 events in 154 patients).
During follow-up, the cost differences in mean total payer costs were 640 euros (P = .012), 364 British pounds (P = .013) and $925 (P = .016) per patient in favor of cryoballoon ablation. As a result, total cost savings in the trial period were 245,000 euros, 140,000 pounds and $355,000.
The reduced need with cryoballoon for repeat ablations and the low rate of CV rehospitalizations were responsible for the cost savings to the payer during the trial period, the researchers wrote.
It was also noted that cost savings were evident across multiple health systems.
“These changes are intended to cause hospitals and payers to share incentives to improve the quality and reduce the cost of health care, including reducing the occurrence of [health care utilizations],” Chun and colleagues wrote. “From a patient perspective, depending on the insurance arrangement, there may be a desire to reduce out-of-pocket expenses associated with additional health care use.” – by Dave Quaile
Disclosures: The study was funded by Medtronic. All authors report receiving institutional funding from Medtronic. There were no personal fees provided to the investigators for article development.
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