A meta-analysis and cost-minimization analysis of cryoballoon ablation versus radiofrequency ablation for paroxysmal atrial fibrillation

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Arrhythmia Pub Date : 2024-06-09 DOI:10.1002/joa3.13055

Yoshimi Nitta MSPH, Michiko Nishimura MSc, Hidetoshi Shibahara PhD, Teiichi Yamane MD, PhD

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Abstract

Background

Previous studies have shown inconsistent results in clinical effectiveness between cryoballoon ablation (CBA) and radiofrequency ablation (RFA), and cost assessment between the procedures is important. The aim of this study was to evaluate the clinical effectiveness and cost-effectiveness between the procedures in patients with paroxysmal atrial fibrillation (AF) refractory to antiarrhythmic drug therapy.

Methods

A systematic review and meta-analysis were performed. The primary outcome for the meta-analysis was long-term AF recurrence. Following the results of the meta-analysis, the cost-effectiveness of CBA versus RFA in Japan was assessed.

Results

The meta-analysis included 12 randomized controlled trials and six propensity-score matching cohort studies. AF recurrence was slightly lower in patients referred for CBA than for RFA, with an integrated risk ratio of 0.93 (95% confidence interval: 0.81–1.07) and an integrated hazard ratio of 0.96 (95% confidence interval: 0.77–1.19), but no significant difference was found. A cost-minimization analysis was conducted to compare the medical costs of CBA versus RFA because there was no significant difference in the risk of AF recurrence between the procedures. The estimated costs for CBA and RFA were JPY 4 858 544 (USD 32 390) and JPY 4 505 255 (USD 30 035), respectively, with cost savings for RFA of JPY 353 289 (USD 2355).

Conclusion

Our meta-analysis suggests that CBA provides comparable benefits with regard to AF recurrence compared with RFA, as shown in previous studies. Although the choice of treatment should be based on patient and treatment characteristics, RFA was shown that it might be cost saving as compared to CBA.

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冷冻球囊消融术与射频消融术治疗阵发性心房颤动的荟萃分析和成本最小化分析

以往的研究表明，冷冻球囊消融术（CBA）和射频消融术（RFA）的临床疗效并不一致，因此对这两种手术的成本进行评估非常重要。本研究旨在评估抗心律失常药物治疗难治性阵发性心房颤动（房颤）患者的临床疗效和成本效益。荟萃分析的主要结果是房颤长期复发。荟萃分析包括 12 项随机对照试验和 6 项倾向分数匹配队列研究。接受 CBA 治疗的患者房颤复发率略低于接受 RFA 治疗的患者，综合风险比为 0.93（95% 置信区间：0.81-1.07），综合危险比为 0.96（95% 置信区间：0.77-1.19），但未发现显著差异。由于两种手术的房颤复发风险没有显著差异，因此进行了成本最小化分析，以比较 CBA 和 RFA 的医疗成本。CBA 和 RFA 的估计成本分别为 4 858 544 日元（32 390 美元）和 4 505 255 日元（30 035 美元），RFA 节省的成本为 353 289 日元（2355 美元）。尽管治疗方法的选择应基于患者和治疗特点，但与 CBA 相比，RFA 可节省费用。

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