SAN FRANCISCO, CA — An analysis of US implantable cardioverter-defibrillator (ICD) patients undergoing ventricular tachycardia (VT) ablation shows hospitalizations, emergency-department visits, and rhythm-related healthcare costs decrease after ablation.
The percentage of patients with at least one rhythm-related hospitalization dropped significantly from 53% in the year before ablation to 28% in the year after ablation (P<0.0001).
While office visits held steady at a median of three pre- and postablation, the percentage of patients with an emergency-department visit dropped from 41% to 26% (P<0.0001).
Together this drove median annual rhythm-related medical expenditures down $5408 from $7318 to $1910 (P<0.0001) and outpatient medical expenditures down $960 from $2338 to $1378 (P=0.005), Dr Jeffrey Winterfield (Loyola University, Maywood, IL) reported in a poster at the Heart Rhythm Society (HRS) 2016 Scientific Sessions.
"What was most interesting is if you look at the 365 days before ablation and the 365 days afterward, you see a rise in costs, and really it begins in the 6 months leading up to day zero, or to the ablation day, and then it flattens out again," he said. "This kind of makes sense; they're storming and they're using more healthcare resources leading up to it."
The study had been planned as part of the now-canceled STAR-VT trial and was based on the hypothesis that costs could be cut by ablating VT sooner.
Ultimately, MarketScan claims data were used from 543 ICD or cardiac-resynchronization therapy with a defibrillator (CRT-D) patients who had private or Medicare supplemental insurance from April 2008 to March 2013. Their average age was 64.1 years, and 86.8% were male.
The investigators thought there might be a reduction in drug costs postablation, but overall that was not the case, likely because practitioners will often keep patients on drugs after ablation, said Winterfield. Pre- and postablation, median payments for all drug classes were $3252 vs $3155 (P=0.02) and $61 vs $69 for antiarrhythmics (P=0.02).
"Perhaps we should consider ablation sooner in the life cycle of VT," he concluded. "Once VT sets in, it's fair to say that it will come back and may come back with higher frequency, and in that setting we know that heart-failure hospitalizations go up and quality of life diminishes with recurrent . . . therapies, and healthcare utilization goes up."
Winterfield reported serving as a speaker for and compensation for services from Biotronik and St Jude Medical.
Heartwire from Medscape © 2016
Cite this: Ventricular Tachycardia Ablation Reduces Healthcare Costs, Not Just Shocks for ICD Patients - Medscape - May 05, 2016.