OBJECTIVES: To evaluate the cost-effectiveness of cryo-balloon cryoablation (CB-2) in the treatment of paroxysmal, persistent or persistent long-term atrial fibrillation (AF) compared to radiofrequency ablation (RF), from the perspective of the Brazilian private health system.

METHODS: A decision tree model was developed from a private payer perspective. The target population was patients with AF in the paroxysmal, persistent or persistent long-term phase. Clinical outcomes were defined as the rate of recurrence of atrial tachyarrhythmia, and complications were included as a secondary outcome. Recurrence rates were identified through literature. The analysis considered the direct medical cost of performing the ablation procedure, taken from 2018 private insurance pricing charts (CBHPM) and presented in 2019 BRL and USD. Indirect costs were not included in the analysis. No discount rate was applied. A univariate sensitivity analysis was conducted.

RESULTS: Treatment with CB-2 presented a total cost of BRL 8,468 (USD 2,117), with a 21% recurrence rate of atrial tachyarrhythmia. Current standard of care treatment presented a total cost of BRL 9,098 (USD 2,274) with a 30% recurrence rate of atrial tachyarrhythmia. As such, the model estimated lower costs and a superior clinical profile associated with CB-2, thus representing a dominant strategy when compared to RF ablation. The sensitivity analysis indicated that the results were robust to variations in both cost and effectiveness variables. The cost of the ablation procedure was the parameter with the greatest impact on the analysis results.

CONCLUSIONS:The cost-effectiveness analysis indicates that cryo-balloon cryoablation is likely to offer lower costs and a better prognosis - a reduction of the recurrence rate of atrial tachyarrhythmia - compared to radiofrequency ablation and should therefore be considered in the private healthcare system in Brazil.