title: Physician-controlled costs: the choice of equipment used for atrial fibrillation ablation.
abstract: OBJECTIVE
  Atrial fibrillation (AF) ablation uses expensive technology and equipment. Physicians have considerable latitude over equipment choice. Average Medicare reimbursement is $10,338 for uncomplicated AF ablations. The purpose of this study is to evaluate the cost of special equipment chosen by physicians to perform AF ablation.
  
  
  METHODS
  We obtained the list price cost of special capital equipment and of disposable equipment (intracardiac ultrasound probes, transseptal needles/sheaths, and ablation/recording catheters) commonly used for radiofrequency (RF) AF ablation. We also evaluated the equipment cost of using robotic magnetic navigation and cryoablation. Then we evaluated costs for several physician equipment choice scenarios.
  
  
  RESULTS
  Using open irrigated-tip catheters, the lowest estimated cost-per-case for manual RF ablation of AF was $6,637, and the highest estimated cost of manual RF ablation was $12,603. Assuming 200 AF ablations/year and a 6-year magnet life, the cost-per-case of using magnetic navigation ablation ranged from $12,261-$15,464. The cost-per-case using cryoballoons alone ranged from $12,847-$15,320, and if focal cryoablation or RF touch-up is needed, cryoablation cost increased to $15,942-$22,284.
  
  
  CONCLUSIONS
  Physicians have many choices in AF ablation equipment. Equipment costs in our arbitrary scenarios range from $6,637 to $22,284 per case. More important than the specific cost of each scenario is the concept that these are physician-driven costs, and as such, physicians will need to determine if more expensive technologies increase procedural efficacy and/or patient safety enough to justify the greater procedural equipment costs.
authors.affiliation: From Silicon Valley Cardiology and Sequoia Hospital, 1950 University Avenue, Suite 160, E. Palo Alto, CA 94303, Redwood City, USA. rawinkle@aol.com
authors.forename: Roger A
authors.initials: RA
authors.lastname: Winkle
authors.forename: R Hardwin
authors.initials: RH
authors.lastname: Mead
authors.forename: Gregory
authors.initials: G
authors.lastname: Engel
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Kong
authors.forename: Rob A
authors.initials: RA
authors.lastname: Patrawala
mesh_terms: D001281:Atrial Fibrillation / Q000191:economics* / Q000628:therapy*; D017115:Catheter Ablation / Q000191:economics* / Q000295:instrumentation* / Q000379:methods; D057785:Catheters / Q000191:economics; D002755:Choice Behavior; D002983:Clinical Competence; D003365:Costs and Cost Analysis; D004209:Disposable Equipment / Q000191:economics; D004867:Equipment Design; D006801:Humans; D010820:Physicians; D012371:Robotics / Q000191:economics; D014481:United States