OBJECTIVES: Atrial fibrillation is the most common arrhythmia in the clinical practice. It is related with an important morbidity, a decrease in patients’ quality of life and is a risk factor of suffering a stroke. The Spanish estimated atrial fibrillation prevalence is 2.52%, and is higher over 60 years.  Radiofrequency surgical ablation is a treatment alternative to restore sinus rhythm in drug-refractory atrial fibrillation patients. The main objective of this study is to develop a five-year cost-utility analysis including the different treatment alternatives in drug-refractory concomitant atrial fibrillation patients in the Spanish setting. METHODS: A Markov model was developed to simulate the evolution of a 1000 cohort of over 40 years old patients with paroxistical and persistent atrial fibrillation that could be treated with: non ablation, surgical ablation and catheter ablation. The model included four heath states: sinus rhythm, atrial fibrillation, dependent stroke and death. The time horizon was five years, with a cycle length of three months. The data of cost and effects were obtained from the published literature and experts opinion. Costs and effects were discounted at 3.5%. A sensibility analysis was developed to determine the robustness of the main variables of the model. RESULTS: Based on 1000 patients simulation with concomitant atrial fibrillation, preliminary results show that the QALY gained were 3.79, 4.25, and 4.23, respectively for no ablation, surgical ablation and catheter ablation. The costs per patient were respectively 8,889, 11,157 and 11,865. The cost per QALY gained of the most effectiveness option (surgical ablation) when compared with no ablation is €4909. Surgical ablation is a dominant option vs. catheter ablation. CONCLUSIONS: These preliminary results show that surgical ablation is a cost-effective treatment option in drug refractory concomitant atrial fibrillation patients in the Spanish setting, with less cost and a higher efficacy than the catheter ablation.