Impact of wait times for atrial fibrillation ablation on cumulative health care costs.

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

This study aimed to determine drivers of health care expenses by phase of cost and assess the 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 health care costs were the primary outcome, presented by phase of cost from AF diagnosis to 1 year after 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 8403 recipients of de novo AF ablation with a median diagnosis-to-ablation time of 29 months (interquartile range 16-50). The median (interquartile range) preablation cost was $15,353 ($8424-$27,776), whereas the median 1-year postablation cost was $19,929 ($16,595-$25,702). Diagnosis-to-ablation time was significantly associated with increased preablation costs (rate ratio [RR] 1.02 per month; 95% confidence interval [CI] 1.02-1.02). Wait times were positively associated with postablation 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 preablation (RR 1.28; 95% CI 1.24-1.33) and postablation costs.

CONCLUSION

Patients receiving AF ablation experience distinct phases of cost accumulation, and wait times for ablation have a limited contribution to cumulative costs.