Impact of wait-times for atrial fibrillation ablation on cumulative healthcare 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 — To determine drivers of healthcare expenses by phase of cost and assess 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 healthcare costs were the primary outcome, presented by phase of cost from AF diagnosis to 1 year following 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 8,403 recipients of de novo AF ablation with a median diagnosis-to-ablation time of 29 (IQR: 16-50) months. The median (IQR) pre-ablation cost was $15,353 ($8,424-$27,776) while the median 1-year cost post-ablation was $19,929 ($16,595-$25,702). Diagnosis-to-ablation time was significantly associated with increased pre-ablation costs (Rate ratio [RR] 1.02 per month, 95% CI 1.02-1.02). Wait-times were positively associated with post-ablation 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 pre-ablation (RR 1.28, 95% CI 1.24-1.33) and post-ablation costs.

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