title: Total costs and atrial fibrillation ablation success or failure in Medicare-aged patients in the United States.
abstract: BACKGROUND
  This retrospective cohort study compared the direct medical costs of successful versus unsuccessful catheter ablation in Medicare-aged patients with atrial fibrillation (AF), using medical claims data.
  
  
  METHODS
  AF patients with > or = 12 months of continuous medical/pharmacy coverage pre- and postablation were identified from the MarketScan Medicare database (January 2003 to December 2006). For study inclusion, patients were required to have > or = 2 AF inpatient/outpatient visits within 6 months and to have received antiarrhythmic drug therapy within 12 months prior to the index ablation. Ablation success was defined as the absence of antiarrhythmic drug therapy 6-12 months postablation.
  
  
  RESULTS
  Of 135 patients identified (67% men, mean age 73 years), ablation was successful in 69 (51.1%); most patients (96%) underwent a single procedure. Patients with successful ablation discontinued antiarrhythmic drug treatment after (mean) 54 days. Use of rate-control and anticoagulant drugs decreased after successful ablation, from 87% to 67% and from 86% to 64% of patients, respectively. Among failed ablation patients, 74% versus 70% received rate-control drugs, and 88% versus 82% received anticoagulants pre- versus postablation. Mean +/- SD per-patient procedural costs were $13,655+/-$12,761 for successful compared with $17,294+/-$26,502 (P=0.21) for failed ablation, while AF-related medical costs over 12 months postablation were $2394+/-$642 and $2703+/-$1706, respectively (P<0.001). Overall costs tended to be lower for successful ($16,049+/-$12,536) than for failed ($19,997+/-$13,958) AF ablation (P=0.07). These findings are subject to the limitations imposed by a retrospective database analysis and a small sample size.
  
  
  CONCLUSIONS
  Outside the clinical-trial setting, catheter ablation for second-line treatment of AF proved unsuccessful in half of Medicare-aged patients. Direct medical costs did not differ significantly between patients with failed and successful ablations. The high rate and costs of AF ablation failure in the Medicare-aged population reinforce the need for better understanding of prognostic factors for ablation outcome.
authors.affiliation: Division of Cardiology, Northwestern University, Feinberg School of Medicine, 251 E. Huron St., Feinberg Pavilion, Suite 8-503, Chicago, IL 60611, USA. michael.kim@nmff.org
authors.forename: Michael H
authors.initials: MH
authors.lastname: Kim
authors.forename: Jay
authors.initials: J
authors.lastname: Lin
authors.forename: Charles
authors.initials: C
authors.lastname: Kreilick
authors.forename: Susan H
authors.initials: SH
authors.lastname: Foltz Boklage
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000191:economics / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D017115:Catheter Ablation / Q000191:economics / Q000706:statistics & numerical data; D015897:Comorbidity; D003365:Costs and Cost Analysis; D003710:Demography; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D007344:Insurance Claim Reporting; D008137:Longitudinal Studies; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D006278:Medicare; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
chemical_list: D000889:Anti-Arrhythmia Agents