The Cost-Effectiveness of First-Line Cryoablation vs First-Line Antiarrhythmic Drugs in Canadian Patients With Atrial Fibrillation

Background: The EARLY -AF (NCT02825979), STOP AF First (NCT031 18518), and Cryo-FIRST (NCT01803438) randomised controlled trials (RCTs) demonstrated that cryoballoon pulmonary vein isolation reduces atrial fi brillation (AF) recurrence compared with antiarrhythmic drugs (AADs) in patients with symptomatic paroxysmal atrial fi brillation (PAF). The present study developed a cost-effectiveness model (CEM) of fi rst - line cryoablation compared with fi rst -line AADs for PAF, from the Canadian health care payer ' s perspective. Methods: Data from the 3 RCTs were analysed to estimate key CEM parameters. The model structure used a decision tree for the fi rst 12 months and a Markov model with a 3 -month cycle length for the remaining lifetime time horizon. Costs were set at 2023 Canadian dollars, health bene fi ts were expressed as quality -adjusted life years (QALYs), and both were discounted 3% annually. Probabilistic sensitivity analysis (PSA) considered parameter uncertainty. Results: The statistical analysis estimated that fi rst -line cryoablation generates a 47% reduction ( P < 0.001) in the rate of AF recurrence, a 73% reduction in the rate of subsequent ablation ( P < 0.001), and a 4.3% ( P = 0.025) increase in health -related quality of life, compared with fi rst -line AADs. The PSA indicates that an individual treated with fi rst -line cryoablation accrues less costs ( - $3,862) and more QALYs (0.19) compared with fi rst -line AADs. Cryoablation is cost -saving in 98.4% of PSA iterations and has a 99.9% probability of being costeffective at a cost-effectiveness threshold of $50,000 per QALY gained. Cost-effectiveness results were robust to changes in key model parameters. Conclusions: First -line cryoballoon ablation is cost-effective when compared with AADs for patients with symptomatic PAF.