Total costs and atrial fibrillation ablation success or failure in medicare-aged patients in the United States

Introduction: 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 ≤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 ≤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. Conclusion: 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.