The Impact of First Procedure Success Rate on the Economics of Atrial Fibrillation Ablation

Moussa Mansour, Edward Karst, E. Kevin Heist, Nirav Dalal, Jason H. Wasfy, Douglas L Packer, Hugh Calkins, Jeremy N. Ruskin, Srijoy Mahapatra

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to compare health care costs associated with repeat ablation of atrial fibrillation (AF) with health care costs associated with a successful first procedure. Background: Catheter ablation has become established as a rhythm control strategy for symptomatic paroxysmal and persistent AF. The economic impact of ablation is not completely understood, and it may be affected by repeat procedures performed for recurrent AF. Methods: The source of data was the MarketScan (Truven Health, Ann Arbor, Michigan) administrative claims dataset from April 2008 to March 2013, including U.S. patients with private and Medicare supplemental insurance. Patients who underwent an outpatient atrial ablation procedure and a diagnosis of AF were identified. Total health care cost was calculated for 1 year before and after the ablation. Patients were categorized as having undergone a repeat ablation if an additional ablation was performed in the following year. Results: Of 12,027 patients included in the study, repeat ablation was performed in 2,066 (17.2%) within 1 year. Patients with repeat ablation had higher rates of emergency department visits (43.4% vs. 32.2%; < 0.001) and subsequent hospitalization (35.6% vs. 21.5%; p < 0.001), after excluding hospitalizations for the repeat procedure. Total medical cost was higher for patients with repeat ablation ($52,821 vs. $13,412; p < 0.001), and it remained 46% higher even after excluding the cost associated with additional ablations ($19,621 vs. $13,412; p < 0.001). Conclusions: Health care costs are significantly higher for patients with a repeat ablation for AF than for patients with only a single ablation procedure, even though both groups have similar baseline characteristics. The increased costs persist even after excluding the cost of the repeat ablation itself. These results emphasize the economic benefit of procedural success in AF ablation.

Original languageEnglish (US)
JournalJACC: Clinical Electrophysiology
DOIs
StateAccepted/In press - Mar 28 2016

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Atrial Fibrillation
Economics
Health Care Costs
Costs and Cost Analysis
Hospitalization
Catheter Ablation
Information Storage and Retrieval
Medicare
Insurance
Hospital Emergency Service
Outpatients
Health

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Outcomes research

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

The Impact of First Procedure Success Rate on the Economics of Atrial Fibrillation Ablation. / Mansour, Moussa; Karst, Edward; Heist, E. Kevin; Dalal, Nirav; Wasfy, Jason H.; Packer, Douglas L; Calkins, Hugh; Ruskin, Jeremy N.; Mahapatra, Srijoy.

In: JACC: Clinical Electrophysiology, 28.03.2016.

Research output: Contribution to journalArticle

Mansour, Moussa ; Karst, Edward ; Heist, E. Kevin ; Dalal, Nirav ; Wasfy, Jason H. ; Packer, Douglas L ; Calkins, Hugh ; Ruskin, Jeremy N. ; Mahapatra, Srijoy. / The Impact of First Procedure Success Rate on the Economics of Atrial Fibrillation Ablation. In: JACC: Clinical Electrophysiology. 2016.
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abstract = "Objectives: The purpose of this study was to compare health care costs associated with repeat ablation of atrial fibrillation (AF) with health care costs associated with a successful first procedure. Background: Catheter ablation has become established as a rhythm control strategy for symptomatic paroxysmal and persistent AF. The economic impact of ablation is not completely understood, and it may be affected by repeat procedures performed for recurrent AF. Methods: The source of data was the MarketScan (Truven Health, Ann Arbor, Michigan) administrative claims dataset from April 2008 to March 2013, including U.S. patients with private and Medicare supplemental insurance. Patients who underwent an outpatient atrial ablation procedure and a diagnosis of AF were identified. Total health care cost was calculated for 1 year before and after the ablation. Patients were categorized as having undergone a repeat ablation if an additional ablation was performed in the following year. Results: Of 12,027 patients included in the study, repeat ablation was performed in 2,066 (17.2{\%}) within 1 year. Patients with repeat ablation had higher rates of emergency department visits (43.4{\%} vs. 32.2{\%}; < 0.001) and subsequent hospitalization (35.6{\%} vs. 21.5{\%}; p < 0.001), after excluding hospitalizations for the repeat procedure. Total medical cost was higher for patients with repeat ablation ($52,821 vs. $13,412; p < 0.001), and it remained 46{\%} higher even after excluding the cost associated with additional ablations ($19,621 vs. $13,412; p < 0.001). Conclusions: Health care costs are significantly higher for patients with a repeat ablation for AF than for patients with only a single ablation procedure, even though both groups have similar baseline characteristics. The increased costs persist even after excluding the cost of the repeat ablation itself. These results emphasize the economic benefit of procedural success in AF ablation.",
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AU - Wasfy, Jason H.

AU - Packer, Douglas L

AU - Calkins, Hugh

AU - Ruskin, Jeremy N.

AU - Mahapatra, Srijoy

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AB - Objectives: The purpose of this study was to compare health care costs associated with repeat ablation of atrial fibrillation (AF) with health care costs associated with a successful first procedure. Background: Catheter ablation has become established as a rhythm control strategy for symptomatic paroxysmal and persistent AF. The economic impact of ablation is not completely understood, and it may be affected by repeat procedures performed for recurrent AF. Methods: The source of data was the MarketScan (Truven Health, Ann Arbor, Michigan) administrative claims dataset from April 2008 to March 2013, including U.S. patients with private and Medicare supplemental insurance. Patients who underwent an outpatient atrial ablation procedure and a diagnosis of AF were identified. Total health care cost was calculated for 1 year before and after the ablation. Patients were categorized as having undergone a repeat ablation if an additional ablation was performed in the following year. Results: Of 12,027 patients included in the study, repeat ablation was performed in 2,066 (17.2%) within 1 year. Patients with repeat ablation had higher rates of emergency department visits (43.4% vs. 32.2%; < 0.001) and subsequent hospitalization (35.6% vs. 21.5%; p < 0.001), after excluding hospitalizations for the repeat procedure. Total medical cost was higher for patients with repeat ablation ($52,821 vs. $13,412; p < 0.001), and it remained 46% higher even after excluding the cost associated with additional ablations ($19,621 vs. $13,412; p < 0.001). Conclusions: Health care costs are significantly higher for patients with a repeat ablation for AF than for patients with only a single ablation procedure, even though both groups have similar baseline characteristics. The increased costs persist even after excluding the cost of the repeat ablation itself. These results emphasize the economic benefit of procedural success in AF ablation.

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