Healthcare Utilization and Costs Reduction after Radiofrequency Ablation For Atrial Fibrillation in the Brazilian Private Healthcare System

Abstract

BackgroundAtrial fibrillation (AF) is the most common arrhythmia worldwide, with significantly associated hospitalizations. Considering its growing incidence, the AF related economic burden to healthcare systems is increasing. Healthcare expenditures might be substantially reduced after AF radiofrequency ablation (AFRA).ObjectiveTo compare resource utilization and costs before and after AFRA in a cohort of patients from the Brazilian private healthcare system.MethodsWe conducted a retrospective cohort study, based on patients’ billing information from an administrative database. Eighty-three adult patients who had an AFRA procedure between 2014 and 2015 were included. Healthcare resource utilization related to cardiovascular causes, including ambulatory and hospital care, as well as its costs, were analyzed. A p-value of less than 0.05 was considered statistically significant.ResultsMean follow-up was 14.7 ± 7.1 and 10.7 ± 5.4 months before and after AFRA, respectively. The 1-year AF recurrence-free rate was 83.6%. Before AFRA, median monthly total costs were Brazilian Reais (BRL) 286 (interquartile range [IQR]: 137-766), which decreased by 63.5% (p = 0.001) after the procedure, to BRL 104 (IQR: 57-232). Costs were reduced both in the emergency (by 58.6%, p < 0.001) and outpatient settings (by 56%, p < 0.001); there were no significant differences in the outpatient visits, inpatient elective admissions and elective admission costs before and after AFRA. The monthly median emergency department visits were reduced (p < 0.001).ConclusionIn this cohort, overall healthcare costs were reduced by 63.5%. A longer follow-up could be useful to evaluate if long-term cost reduction is maintained.

Começa a Temporada de Frio nos Trópicos. A Crioablação da Fibrilação Atrial no Brasil

“…A careful analysis of new treatment modalities is justified to demonstrate their real benefits within the reality of the Brazilian health system. A recent publication, demonstrated marked cost reductions for the healthcare system in patients submitted to atrial fibrillation ablation in Brazil, 5 which seems to reinforce the importance of ablation for the management of patients with atrial fibrillation in our country. Another study very elegantly demonstrated the cost benefits of cryoablation when compared to radiofrequency ablation in the Brazilian public health system.…”

Fibrilação Atrial (Parte 2) – Ablação por Cateter

“…Há sólidas evidências de redução de hospitalizações 80 e uso de recursos, com relação custo-benefício favorável. 10 Nesse cenário, deve-se priorizar pacientes com alta probabilidade de sucesso (jovens, FA paroxística, sem remodelamento atrial significativo).…”

“…There is solid evidence of reduction of hospitalizations 80 and resource utilization, with favorable cost-effectiveness. 10 In this scenario, patients with a higher probability of success should be prioritized (young people, paroxysmal AF, without significant atrial remodeling).…”

“…Técnicas utilizando a ablação por cateter foram desenvolvidas e aperfeiçoadas, visando à eliminação dos focos geradores da FA por meio da ablação circunferencial ao redor das VP, 2 - 4 com índices de sucesso e performance superiores quando comparados com a melhor terapêutica farmacológica. 5 - 10 …”

“…Techniques using catheter ablation were developed and improved to eliminate AF-generating foci through circumferential ablation around the PVs, 2 - 4 with higher success and performance rates compared to the best pharmacological therapy. 5 - 10 …”