Healthcare Costs Drop Sharply After Successful AF Ablation

Marlene Busko

May 04, 2016

SAN FRANCISCO, CA — In an insurance-claims-based study of close to 10,000 patients in the US who had ablation for atrial fibrillation, half of the patients did not require a repeat ablation and had no complications (including the use of antiarrhythmic drugs) in the following year, and their mean healthcare costs dropped by 40%[1].

However, many other patients incurred added costs, which suggests that striving to do better would not only benefit patients but would also cut costs, and this study provides a glimpse of the potential cost savings.

Dr Moussa C Mansour (Massachusetts General Hospital, Boston) presented the study May 4, 2016 in a poster at the Heart Rhythm Society (HRS) 2016 Scientific Sessions.

A "successful ablation" was defined as having none of the following: repeat ablation, antiarrhythmic drug use, vascular-access complications, pulmonary edema, pericarditis, perforation/tamponade, or pulmonary-vein stenosis.

In patients who had a successful ablation, the estimated mean healthcare costs per patient dropped from $24,781 in the year before the procedure to $14,823 in the year after the procedure (P<0.001).

The study highlights that it is important for clinicians and care centers to take systematic steps to try to optimize outcomes for patient who undergo ablation for AF—not only to benefit the patient (which is key), but also to save healthcare dollars, Mansour told heartwire from Medscape.

Concerted efforts to reduce repeat procedures, reduce complications, and make the procedure more successful will not only ease the suffering of patients with AF but could save the healthcare system many thousands of dollars, he said.

Estimating Cost-effectiveness of Catheter AF Ablation

The cost-effectiveness of catheter ablation for AF depends on the patient selection, tools, and technique, Mansour and colleagues write.

They aimed to estimate how the cost of caring for a patient with AF in the US in the year after an ablation procedure differs from healthcare expenditures in the preceding year.

The researchers analyzed insurance-claims data from the MarketScan database of patients who had a first catheter ablation during April 2009 to March 2012. To be included in the study, patients had to be diagnosed with AF at the time of the ablation and have insurance-claims data (either with Medicare or private insurance) for the year before and the year after the procedure.

They identified 9949 patients who met these criteria; they had a mean age of 61, and 71% were male.

Half of the patients (5004 patients) had successful ablations, and their mean insurance claims for medical care and drugs totaled $14,823 per person in the year following the procedure (a cost saving of $9958).

However, the other half of the patients incurred added costs ranging from around $4000/year for antiarrhythmic drugs (almost one in four patients) to $29,000/year for repeat ablation (almost two in 10 patients) to around $33,000/year for pulmonary edema (which was rarer).

Incremental Costs of Care in the Year Following AF Ablation

Clinical event % of patients Incremental cost/patient/year ($)
Antiarrhythmic drugs 39 4332
Repeat ablation 17 29,028
Vascular complication 5 15,631
Pulmonary edema 4 32,885
Pericarditis Approximately 2 5712
Perforation/tamponade Approximately 2 8382
Pulmonary-vein stenosis Approximately 1 5585

"This is real-world data that show that a large number of patients are getting redo ablations and complications," Mansour pointed out.

"Tools and techniques aimed at reducing events after ablation would further improve the procedure's cost-effectiveness," the researchers conclude.

Mansour is a consultant for St Jude Medical, Biosense Webster, Boston Scientific, and Biotronik and receives research grants from St Jude Medical and Biosense Webster.

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