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Open Access 20-01-2024 | Antiarrhythmic Drugs | Original Research Article

An Economic Evaluation of a Streamlined Day-Case Atrial Fibrillation Ablation Protocol and Conventional Cryoballoon Ablation versus Antiarrhythmic Drugs in a UK Paroxysmal Atrial Fibrillation Population

Authors: Joe W. E. Moss, Derick Todd, Lukasz Grodzicki, Beatrice Palazzolo, Richard Mattock, Stuart Mealing, Maxim Souter, Benedict Brown, Tom Bromilow, Damian Lewis, James McCready, Muzahir Tayebjee, Ewen Shepherd, Thiagarajah Sasikaran, Clare Coyle, Eleni Ismyrloglou, Nicholas A. Johnson, Prapa Kanagaratnam

Published in: PharmacoEconomics - Open | Issue 3/2024

Abstract

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.

Available only for authorised users

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Title: An Economic Evaluation of a Streamlined Day-Case Atrial Fibrillation Ablation Protocol and Conventional Cryoballoon Ablation versus Antiarrhythmic Drugs in a UK Paroxysmal Atrial Fibrillation Population
Authors: Joe W. E. Moss
Derick Todd
Lukasz Grodzicki
Beatrice Palazzolo
Richard Mattock
Stuart Mealing
Maxim Souter
Benedict Brown
Tom Bromilow
Damian Lewis
James McCready
Muzahir Tayebjee
Ewen Shepherd
Thiagarajah Sasikaran
Clare Coyle
Eleni Ismyrloglou
Nicholas A. Johnson
Prapa Kanagaratnam
Publication date: 20-01-2024
Publisher: Springer International Publishing
Keywords: Antiarrhythmic Drugs
Atrial Fibrillation
Published in: PharmacoEconomics - Open / Issue 3/2024
Print ISSN: 2509-4262
Electronic ISSN: 2509-4254
DOI: https://doi.org/10.1007/s41669-023-00471-6

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An Economic Evaluation of a Streamlined Day-Case Atrial Fibrillation Ablation Protocol and Conventional Cryoballoon Ablation versus Antiarrhythmic Drugs in a UK Paroxysmal Atrial Fibrillation Population

Abstract

Background and Aims

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and Aims

Methods

Results

Conclusions

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