Abstract 12178: Cost Minimization Analysis of Selective Ablation Compared to Ablating All Atrial Fibrillation Patients Using DECAAF Trial Data
Objective: The objective of the study was a cost minimization analysis to investigate the financial impact of selective ablation compared to ablating all Atrial fibrillation (AF) patients.
Methods: Participants of the DECAAF trial (n=261), prospective multicenter blinded study, were categorized to Utah Stage I (n=49, 19%), II (n=107, 41%), III (n=81, 31%), and Stage IV (n=24, 9%) based on the degree of atrial structural remodeling (SRM, Stage I: ≤10%, Stage II: 10-≤20%, Stage III: 20-≤30%, and Stage IV: 30-≤40%) quantified using delayed enhancement magnetic resonance imaging (DE-MRI). The proportion of patients with post ablation AF recurrence for Utah Stage I-IV was 16.33%, 30.84%, 45.68%, and 58.33% respectively. A decision tree was constructed to compare 1 year costs in selective ablation arm to ablating all AF patients arm. Selective ablation was defined as ablating Stage I and II AF patients and medically managing Stage III and IV AF patients. Probabilities were obtained from the DECAAF trial. Costs associated with ablation procedure, AF recurrence, anticoagulation treatment, and annual AF treatment were obtained from the literature. Sensitivity analysis was conducted by varying ablation and MRI costs.
Results: The mean total per patient cost in selective ablation arm was $24,384 compared to $27,297 for ablating all patients arm. The higher cost of ablating all AF patients was associated with higher AF recurrence rate and cost associated with treating AF annually. Sensitivity analysis of ablation costs demonstrated no change while MRI costs up to $5000 per patient showed economic benefit for selective ablation compared to ablating all patients.
Conclusion: Selective ablation based on degree of SRM is clinically and economically beneficial with cost savings of $2,910 per person compared to the current standard of ablating AF patients regardless of the degree of SRM.
- © 2013 by American Heart Association, Inc.