Cost comparison of catheter ablation and medical therapy in atrial fibrillation.
BACKGROUND
There is emerging evidence for clinical superiority of catheter ablation over rate and rhythm control strategies in paroxysmal atrial fibrillation (PAF). The objective of this study was to compare costs related to medical therapy versus catheter ablation for PAF in Ontario (Canada).


METHODS
Costs related to medical therapy in the analysis included the cost of anticoagulation, rate and rhythm control medications, noninvasive testing, physician follow-up visits, and hospital admissions, as well as the cost of complications related to this management strategy. Costs related to catheter ablation were assumed to include the cost of the ablation tools (electroanatomic mapping or intracardiac echocardiography-guided pulmonary vein ablation), hospital and physician billings, and costs related to periprocedural medical care and complications. Costs related to these various elements were obtained from the Canadian Registry of Atrial Fibrillation (CARAF), government fee schedules, and published data. Sensitivity analyses looking at a range of initial success rates (50-75%) and late attrition rates (1-5%), prevalence of congestive heart failure (CHF) (20-60%), as well as discounting varying from 3% to 5% per year were performed.


RESULTS
The cost of catheter ablation ranged from $16,278 to $21,294, with an annual cost of $1,597 to $2,132. The annual cost of medical therapy ranged from $4,176 to $5,060. Costs of ongoing medical therapy and catheter ablation for PAF equalized at 3.2-8.4 years of follow-up.


CONCLUSIONS
Catheter ablation is a fiscally sensible alternative to medical therapy in PAF with cost equivalence after 4 years.
Southlake Regional Health Center, Newmarket, Ontario, Canada. y.khaykin@utoronto.ca
Yaariv
Y
Khaykin
Carlos A
CA
Morillo
Allan C
AC
Skanes
Aaron
A
McCracken
Karin
K
Humphries
Charles R
CR
Kerr
D000889:Anti-Arrhythmia Agents / Q000191:economics* / Q000627:therapeutic use*; D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D017115:Catheter Ablation / Q000191:economics* / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence
D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants