A Cost Analysis of Catheter Ablation for Atrial Fibrillation: A Canadian Pre-Post Study

There is a paucity of Canadian studies using patient-level data to analyze the costs of catheter ablation (CA) for atrial fibrillation (AF). We sought to identify the health care resource use, costs, and cost predictors of CA. A cost analysis was performed in a population of AF patients treated with CA in Central Zone Nova Scotia from 2010 to 2018. Costs were compared 2 years before ablation (pre-CA) with costs 2 years after (post-CA); the 3-month period post-CA was defined as the treatment window. Costs were also compared according to CA technology defined as before 2015 for patients treated with non-contact force sensing CA and after 2015 for patients treated with contact force sensing CA. Heart failure hospitalizations, AF-related emergency department visits, acute inpatient admissions, and cardioversions all decreased after ablation. The cost difference post-CA vs pre-CA was CAD$18,869 (95% confidence interval [CI], $15,570-$22,168). This increase in costs was driven by costs incurred during the treatment window, which was $21,439 (95% CI, $20,468-$22,409). After excluding treatment window costs, the mean year 1 post-CA cost was $11,223 (95% CI, $9113-$13,334) and year 2 post-CA cost was $4555 (95% CI, $3145-$5965); both were lower than the pre-CA costs. Costs remained stable over the time frame of the study period, with no influence from new technologies on cost. The post-CA cost difference between the post-2015 and pre-2015 groups was $2573 (95% CI, -$2336 to $7481). We showed that although CA is expensive, it might be a cost-effective treatment modality for AF because of the associated reduction in costs and health care resource use. Il existe peu d’études canadiennes utilisant des données sur les patients pour analyser les coûts de l’ablation par cathéter (AC) de la fibrillation auriculaire (FA). Notre étude visait à déterminer l’utilisation des ressources de santé, les coûts et les facteurs prédictifs du coût de l’AC. Une analyse des coûts a été réalisée au sein d’une population de patients atteints de FA traités par AC dans la région sociosanitaire Central de la Nouvelle-Écosse entre 2010 et 2018. Nous avons comparé les coûts 2 ans avant l’ablation (pré-AC) aux coûts 2 ans après l’ablation (post-AC); la période de 3 mois suivant l’AC était définie comme l’intervalle thérapeutique. Nous avons ensuite comparé les coûts en fonction de la technologie d’AC utilisée avant 2015 chez les patients traités par AC sans capteur de force de contact et après 2