Cost comparison of radiofrequency catheter ablation versus cryoablation for atrial fibrillation in hospitals using both technologies

<p><b>Objective:</b> The objective of this study was to compare the cost of radiofrequency (RF) ablation vs cryoablation (Cryo) for atrial fibrillation (AF).</p> <p><b>Methods:</b> This retrospective cohort study used 2013–2014 records from the Premier Healthcare Database for adults with AF catheter ablation. Exclusions included non-AF ablation, surgical ablation, valve replacement or repair, or cardiac implant. Hospitals were required to perform ≥20 procedures using each technology, with the technology identifiable in at least 90% of cases. The primary endpoint was total variable visit cost, modeled separately for inpatient and outpatient visits, and adjusted for patient and hospital characteristics. Technology was categorized as RF or Cryo, with dual-technology procedures classified as Cryo. The Cryo cohort was further divided into Cryo only and Cryo with RF for sensitivity analyses. A composite adverse event endpoint was also compared.</p> <p><b>Results:</b> A total of 1261 RF procedures and 1276 Cryo procedures, of which 500 also used RF, met study criteria. RF patients were slightly older and sicker, and had more cardiovascular disease and additional arrhythmias. Adjusted inpatient costs were $2803 (30.0$2215 (19.5%) higher. Sensitivity models showed higher costs in both Cryo sub-groups compared with RF. Procedural complication rates were not significantly different between cohorts (<i>p</i>-values: 0.4888 inpatient, 0.5072 outpatient).</p> <p><b>Conclusion:</b> AF ablation using RF results in significantly lower costs compared with Cryo, despite an RF population with more cardiovascular disease. This saving cannot be attributed to a difference in complication rates.</p

Sensitivity analysis.

<p>The sensitivity analysis recalculates the net expected cost of each strategy (Scr vs. uNGAL+Scr), varying one model input at a time to its high and low values relative to its baseline value. At both sites, costs of uNGAL+Scr remain lower for each scenario examined in the sensitivity analysis. At NYP-Allen and SIUH, the results are most sensitive to hospital costs and length of stay, costs of additional testing, and the percent of patients with CKD.</p

Simulation model.

<p>A cost simulation model was developed for competing testing strategies to evaluate for AKI; 1) Scr alone, vs. 2) uNGAL plus Scr (uNGAL+Scr). Since the uNGAL+Scr treatment arm provided more diagnostic information, it was regarded as the “gold standard” relative to Scr alone in terms of whether patients should be treated or whether treatment should be delayed.</p

Model input values for each site.

<p>Model input values for each site.</p

Effects on cost per patient.

<p>Effects on Cost Per Patient at NYP-Allen and SIUH. At NYP-Allen, the use of uNGAL+Scr would lead to an expected cost savings of $408 per patient on average, and to similar cost savings of$522 per patient at SIUH. These savings were reflected in lower per patient hospitalization costs and lower additional testing costs.</p