Ablazione transcatetere della fibrillazione atriale

Health Technology Assessment Report dell'Associazione Italiana di Aritmologia e Cardiostimolazione (AIAC)

Translated title of the contribution: Transcatheter ablation of atrial fibrillation: The Health Technology Assessment Report of the Italian Association of Arrhythmology and Cardiostimulation (AIAC)

Sakis Themistoclakis, Massimo Tritto, Emanuele Bertaglia, Patrizia Berto, Maria Grazia Bongiorni, Domenico Catanzariti, Giuseppe De Fabrizio, Roberto De Ponti, Massimo Grimaldi, Claudio Pandozi, Claudio Tondo, Michele Gulizia

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and significantly impact patients'quality of life, morbidity and mortality. The number of affected patients is expected to increase as well as the costs associated with AF management, mainly driven by hospitalizations. Over the last decade, catheter ablation techniques targeting pulmonary vein isolation have demonstrated to be effective in treating AF and preventing AF recurrence. This Health Technology Assessment report of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) aims to define the current role of catheter ablation of AF in terms of effectiveness, efficiency and appropriateness. On the basis of an extensive review of the available literature, this report provides (i) an overview of the epidemiology, clinical impact and socio-economic burden of AF; (ii) an evaluation of therapeutic options other than catheter ablation of AF; and (iii) a detailed presentation of clinical outcomes and cost-benefit ratio associated with catheter ablation. The costs of catheter ablation of AF in Italy were obtained using a bottomup analysis of a resource utilization survey of 52 hospitals that were considered a representative sample, including 4 Centers that contributed with additional unit cost information in a separate questionnaire. An analysis of budget impact was also performed to evaluate the impact of ablation on the management costs of AF. Results of this analysis show that (1) catheter ablation is effective, safe and superior to antiarrhythmic drug therapy in maintaining sinus rhythm; (2) the cost of an ablation procedure in Italy typically ranges from &ευρο;8868 to &ευρο;9455, though current reimbursement remains insufficient, covering only about 60% of the costs; (3) the costs of follow-up are modest (about 8% of total costs); (4) assuming an adjustment of reimbursement to the real cost of an ablation procedure and a 5-10% increase in the annual rate of ablation procedures, after approximately 5-6 years this would result in significant incremental savings for the Italian Healthcare System. In conclusion, catheter ablation of AF is a cost-effective procedure that is inadequately reimbursed in Italy. Insufficient reimbursement may serve as disincentive to perform AF ablation, thereby limiting patient access to this treatment. Considering the healthcare system perspective, higher initial costs for ablation procedures in the short term may be offset by cost savings mainly associated with decreased hospitalizations over time.

Original languageItalian
Pages (from-to)726-776
Number of pages51
JournalGiornale Italiano di Cardiologia
Volume12
Issue number11
DOIs
Publication statusPublished - Nov 2011

Fingerprint

Biomedical Technology Assessment
Atrial Fibrillation
Catheter Ablation
Costs and Cost Analysis
Italy
Hospitalization
Ablation Techniques
Delivery of Health Care
Social Adjustment
Pulmonary Veins
Cost Savings
Anti-Arrhythmia Agents
Budgets
Cost-Benefit Analysis
Motivation
Cardiac Arrhythmias
Epidemiology
Economics
Quality of Life

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ablazione transcatetere della fibrillazione atriale : Health Technology Assessment Report dell'Associazione Italiana di Aritmologia e Cardiostimolazione (AIAC). / Themistoclakis, Sakis; Tritto, Massimo; Bertaglia, Emanuele; Berto, Patrizia; Bongiorni, Maria Grazia; Catanzariti, Domenico; De Fabrizio, Giuseppe; De Ponti, Roberto; Grimaldi, Massimo; Pandozi, Claudio; Tondo, Claudio; Gulizia, Michele.

In: Giornale Italiano di Cardiologia, Vol. 12, No. 11, 11.2011, p. 726-776.

Research output: Contribution to journalArticle

Themistoclakis, S, Tritto, M, Bertaglia, E, Berto, P, Bongiorni, MG, Catanzariti, D, De Fabrizio, G, De Ponti, R, Grimaldi, M, Pandozi, C, Tondo, C & Gulizia, M 2011, 'Ablazione transcatetere della fibrillazione atriale: Health Technology Assessment Report dell'Associazione Italiana di Aritmologia e Cardiostimolazione (AIAC)', Giornale Italiano di Cardiologia, vol. 12, no. 11, pp. 726-776. https://doi.org/10.1714/966.10545
Themistoclakis, Sakis ; Tritto, Massimo ; Bertaglia, Emanuele ; Berto, Patrizia ; Bongiorni, Maria Grazia ; Catanzariti, Domenico ; De Fabrizio, Giuseppe ; De Ponti, Roberto ; Grimaldi, Massimo ; Pandozi, Claudio ; Tondo, Claudio ; Gulizia, Michele. / Ablazione transcatetere della fibrillazione atriale : Health Technology Assessment Report dell'Associazione Italiana di Aritmologia e Cardiostimolazione (AIAC). In: Giornale Italiano di Cardiologia. 2011 ; Vol. 12, No. 11. pp. 726-776.
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