(CCSP040) CATHETER ABLATION IS ASSOCIATED WITH SIGNIFICANT IMPROVEMENTS IN QUALITY OF LIFE AND REDUCTIONS IN HEALTHCARE RESOURCE USE THAT MAY JUSTIFY HIGHER COSTS.

Background: Patients who suffer from Atrial Fibrillation (AF) are high users of healthcare resources and consequently lead to greater costs of management. Treatment with Catheter Ablation (CA) was shown to be a high value treatment however, there is a paucity of recent Canadian studies using patient level data to estimate the costs associated with AF before and after CA. We sought to identify the healthcare resource use, costs, and cost-effectiveness of CA and explore the impact of Contact Force Sensing (CFS) on these parameters.

METHODS AND RESULTS: A Cost–Utility Analysis was performed in a population of AF patients (N=346) treated with CA in Nova Scotia from 2010 – 2018, comparing costs 2 years before ablation (control) to costs 2 years after ablation (intervention). Patient-level data included heart failure (HF) hospitalizations, AF-related Emergency Department (ED) visits, acute care inpatient admissions, and same-day AF cardioversions. The associated costs were sourced from the QEII case costing centre, Nova Scotia Physician Manual, Nova Scotia Drug Formulary, and expert opinion. Costs were calculated in 2021 Canadian Dollars from the Canadian healthcare payer perspective. Quality Adjusted Life Years (QALYs) were sourced from the literature and disutility values were applied according to heart failure events and AF recurrences.

HF hospitalizations, AF-related ED visits, acute inpatient admissions, and cardioversions all decreased during the 2 years after ablation. The estimated cost difference Post-CA vs. Pre-CA was $20,098 (95% CI: $16,868; $23,328). This increase in costs was driven by costs incurred during the treatment window ($22,179; SD $9,189). After excluding treatment window costs, the mean 1-year Post-CA cost was $11,800 (SD $20,091) and $4,870 (SD $13,237) 2-years Post-CA. There was a significant difference only during the Pre-CA period in patients treated with CFS vs. non-CFS CA ($8,352; 95% CI: $4,055; $12,649).

CA contributed to a significant improvement of 0.3097 QALYs (SE 0.014) compared to pharmacological management. The incremental cost-utility ratio (ICUR) was $64,832/QALY (95% CI: $49,964/QALY; $82,464/QALY). With a willingness-to-pay (WTP) threshold of $80,000, the probability of CA being cost effective was 0.96.

Conclusion: We identified a significant difference in costs between CFS and non-CFS treated patients during the period before CA but not after. After exclusion of the cost of CA, the costs post-CA were lower than the pre-CA period. This may be attributed to the lower healthcare resource use seen after ablation. As such, CA appears to be a cost-effective treatment modality for AF given the significant improvement in QALYs.