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