ABC | Volume 113, Nº2, August 2019

Original Article Healthcare Utilization and Costs Reduction after Radiofrequency Ablation For Atrial Fibrillation in the Brazilian Private Healthcare System Eduardo Benchimol Saad, 1 Daiane Oliveira Tayar, 2 Rodrigo Antonini Ribeiro, 3 Silvio Mauro Junqueira Jr., 2 Priscila Andrade, 2 Andre d'Avila 4 Hospital Pró-Cardíaco – Eletrofisiologia, 1 Rio de Janeiro, RJ – Brazil Johnson and Johnson Medical Brasil - Departamento de Economia da Saúde e Mercado de Acesso, 2 São Paulo, SP – Brazil HTANALYZE - Economia da Saúde, 3 Porto Alegre, RS – Brazil Hospital SOS Cardio - Serviço de Arritmia Cardíaca, 4 Florianópolis, SC – Brazil Mailing Address: Daiane Oliveira Tayar • Johnson and Johnson Medical Brazil - Health Economics And Market Access - Av. Presidente Juscelino Kubitschek, 2041. Postal Code 04543-011, São Paulo, SP – Brazil E-mail: dolive27@its.jnj.com , daianed@gmail.com Manuscript received July 23, 2018, revised manuscript November 08, 2018, accepted December 19, 2018 DOI: 10.5935/abc.20190139 Abstract Background: Atrial 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). Objective: To compare resource utilization and costs before and after AFRA in a cohort of patients from the Brazilian private healthcare system. Methods: We 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. Results: Mean 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). Conclusion: In 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. (Arq Bras Cardiol. 2019; 113(2):252-257) Keywords: Catheter Ablation; Arrhythmias Cardiacs; Hospitalization; Hospital Costs; Atrial Fibrillation; Care Costs/trends. Introduction Atrial fibrillation (AF) is a public health problem. Estimates of incidence and prevalence vary worldwide. 1 AF incidence will rise from 1.2 million cases per year in 2010 to 2.6 million cases in 2030; in the same period, prevalence will increase from 5.2 million to 12.1 million. 2 In Brazil, estimates are less clear; a recent study showed a prevalence of 1.8% in the general population. 3 However, considering the ageing of the population in rapidly developing countries such as Brazil, this number will probably increase in the near future. 4 The disease is associated with high healthcare expenditures. In theUSA, the annual cost of AFwas an estimatedUS$26 billion, while in the Euro Heart Survey the estimated combined annual cost in 5 countries (Greece, Italy, the Netherlands, Poland and Spain) was € 6.2 billion. 4 Such expenditures represent a large economic burden: AF is estimated to contribute with more than 1% of total healthcare costs in projections made in 10 high-income countries. 5 The clinical burden is also significant, especially relating to stroke: about a third of patients with the cerebrovascular disease have AF, which in turn incurs in a greater probability of a larger stroke area in brain imaging exams and, therefore, worse prognosis. 6-8 Catheter ablation is an established treatment option for restoration of sinus rhythm, which can increase the quality of life and possibly lead to health care expenditure savings in the long term. 9,10 The reduction in resource consumption and costs can be seen already in the first year of the procedure, and this is maintained in the following years. 11 Even considering the cost of the procedure, it can lead to total healthcare costs reduction after 2 years, especially in younger patients. 12-15 To date, there is scarce data of the economic impact of catheter ablation in middle-income countries, such as Brazil. 252