Longer wait times for atrial fibrillation ablation were associated with increased pre-ablation costs (RR 1.02 per month; 95% CI 1.02-1.02), but had a limited contribution to cumulative costs.
Cohort (n=8,403)
Do wait-times for atrial fibrillation ablation impact cumulative healthcare costs in patients receiving AF ablation?
Wait-times for atrial fibrillation ablation have a limited but statistically significant contribution to cumulative healthcare costs, with medical comorbidities like heart failure being stronger drivers of expense.
Effect estimate: RR 1.02 (95% CI 1.02-1.02)
BACKGROUND Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Substantial wait-times exist for catheter ablation treatment in some jurisdictions. The economic consequences of wait-times have not been characterized. OBJECTIVE To determine drivers of healthcare expenses by phase of cost and assess contribution of wait-times among patients receiving AF ablation. METHODS This observational cohort study included patients who received AF ablation in Ontario, Canada between April 2016 and March 2023. Per-patient cumulative healthcare costs were the primary outcome, presented by phase of cost from AF diagnosis to 1 year following ablation. Hierarchical generalized linear models with a logarithmic link and gamma distribution assessed drivers of cost by phase. The primary exposure was wait-times defined as diagnosis-to-ablation, diagnosis-to-referral, and referral-to-ablation times. RESULTS Our cohort included 8, 403 recipients of de novo AF ablation with a median diagnosis-to-ablation time of 29 (IQR: 16-50) months. The median (IQR) pre-ablation cost was 15, 353 (8, 424-27, 776) while the median 1-year cost post-ablation was 19, 929 (16, 595-25, 702). Diagnosis-to-ablation time was significantly associated with increased pre-ablation costs (Rate ratio RR 1. 02 per month, 95% CI 1. 02-1. 02). Wait-times were positively associated with post-ablation costs (RR 1. 001 per month increase of diagnosis-to-ablation time, 95% CI 1. 000-1. 001), albeit with a smaller magnitude. Medical comorbidity, including heart failure was significantly associated with increased pre-ablation (RR 1. 28, 95% CI 1. 24-1. 33) and post-ablation costs. CONCLUSION Patients receiving AF ablation experience distinct phases of cost accumulation and wait-times for ablation have a limited contribution to cumulative costs.
Qeska et al. (Sun,) conducted a cohort in Atrial fibrillation (n=8,403). Wait-times for AF ablation was evaluated on Per-patient cumulative healthcare costs (RR 1.02, 95% CI 1.02-1.02). Longer wait times for atrial fibrillation ablation were associated with increased pre-ablation costs (RR 1.02 per month; 95% CI 1.02-1.02), but had a limited contribution to cumulative costs.