Assessment of Hospital Charges for Initial and/or Repeat Catheter Ablations for Atrial Fibrillation Performed in 2017, 2018, or 2019

ABSTRACT

Objectives: Catheter ablation for atrial fibrillation (AF) was a novel treatment in 1998. Today, ablations are commonplace and compete with rate/rhythm drugs as first-line therapies. While some ablations are performed as outpatient procedures, many require an overnight hospital stay. Ablations are expensive because they require substantial human and material resources as well as hospital facilities that are subject to inflationary pressures. The aim of this research is to compare hospital charges for catheter ablations performed in the State of Maryland during three consecutive calendar years prior to Covid. Methods: Retrospective analysis of inpatient and outpatient data from 2017, 2018, and 2019 was performed to determine the stability of hospital charges or the amount of change year to year. Charges account for all resources consumed, medical and surgical, in association with any ablation procedure for any form of AF – paroxysmal, persistent, long-term persistent, or permanent. Results: Median charges for ablations performed during a hospital visit without an overnight stay (outpatient) remained steady from year to year – $31,511 (2017), $31,520 (2018), $32,392 (2019). Median charges for an ablation performed during a hospital visit with at least one overnight stay (inpatient) were $47,793 (2017), $48,673 (2018), and $56,670 (2019), reflecting cost stability between 2017 and 2018 but a 15% increase, 2019 versus 2018. Patients undergoing a second ablation within one year were considered to have a repeat ablation. Repeat ablation rates increased from 7.3% to 9.2% for inpatient procedures and from 8.4% to 9.8% for outpatient procedures between 2017 and 2018. Repeat ablation charges covered by private payers were higher than those covered by Medicare. Conclusions: Inpatient charges for catheter ablations are rising in Maryland and so is the re-ablation rate. Cost-containment measures, improvements in ablation procedures and skills, as well as advances in electrophysiology technologies are needed to improve cost-efficiencies.