title: Using Discrete Event Simulation to Model the Economic Value of Shorter Procedure Times on EP Lab Efficiency in the VALUE PVI Study.
abstract: BACKGROUND
  The VALUE PVI study demonstrated that atrial fibrillation (AF) ablation procedures and electrophysiology laboratory (EP lab) occupancy times were reduced for the cryoballoon compared with focal radiofrequency (RF) ablation. However, the economic impact associated with the cryoballoon procedure for hospitals has not been determined.
  
  
  OBJECTIVE
  Assess the economic value associated with shorter AF ablation procedure times based on VALUE PVI data.
  
  
  RESULTS
  A model was formulated from data from the VALUE PVI study. This model used a discrete event simulation to translate procedural efficiencies into metrics utilized by hospital administrators. A 1000-day period was simulated to determine the accrued impact of procedure time on an institution's EP lab when considering staff and hospital resources. The simulation demonstrated that procedures performed with the cryoballoon catheter resulted in several efficiencies, including: (1) a reduction of 36.2% in days with overtime (422 days RF vs 60 days cryoballoon); (2) 92.7% less cumulative overtime hours (370 hours RF vs 27 hours cryoballoon); and (3) an increase of 46.7% in days with time for an additional EP lab usage (186 days RF vs 653 days cryoballoon). Importantly, the added EP lab utilization could not support the time required for an additional AF ablation procedure.
  
  
  CONCLUSIONS
  The discrete event simulation of the VALUE PVI data demonstrates the potential positive economic value of AF ablation procedures using the cryoballoon. These benefits include more days where overtime is avoided, fewer cumulative overtime hours, and more days with time left for additional usage of EP lab resources.
authors.affiliation: Staten Island University Hospital, Dept of Cardiology, 475 Seaview Ave, Staten Island, NY 10305 USA. marcin212@gmail.com.
authors.forename: Marcin
authors.initials: M
authors.lastname: Kowalski
authors.forename: J Brian
authors.initials: JB
authors.lastname: DeVille
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Svinarich
authors.forename: Dan
authors.initials: D
authors.lastname: Dan
authors.forename: Andrew
authors.initials: A
authors.lastname: Wickliffe
authors.forename: Charan
authors.initials: C
authors.lastname: Kantipudi
authors.forename: Jason D
authors.initials: JD
authors.lastname: Foell
authors.forename: Giovanni
authors.initials: G
authors.lastname: Filardo
authors.forename: Reece
authors.initials: R
authors.lastname: Holbrook
authors.forename: James
authors.initials: J
authors.lastname: Baker
authors.forename: Hassan
authors.initials: H
authors.lastname: Baydoun
authors.forename: Mark
authors.initials: M
authors.lastname: Jenkins
authors.forename: Peter
authors.initials: P
authors.lastname: Chang-Sing
mesh_terms: D001281:Atrial Fibrillation / Q000191:economics / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D003452:Cryosurgery / Q000191:economics / Q000379:methods*; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D011667:Pulmonary Veins; D012189:Retrospective Studies; D013997:Time Factors