Duke Center for Atrial Fibrillation, Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
Am J Cardiol. 2014 Jul 15;114(2):266-71. doi: 10.1016/j.amjcard.2014.04.031. Epub 2014 May 2.
Cardiovascular imaging is an important part of procedural planning and safety for catheter ablation of atrial fibrillation (AF). However, the costs of imaging surrounding catheter ablation of AF have not been described. Medicare fee-for-service data were used to evaluate Medicare expenditures before, during, and after catheter ablation for AF from July 2007 to December 2009. Among 11,525 patients who underwent catheter ablation for AF, the mean overall expenditure on the day of the procedure was $14,455 (SD $7,441). The mean imaging expenditure in the periprocedural period, which included the 30 days before the catheter ablation and the day of the ablation itself, was $884 (SD $455). Periprocedural imaging expenditures varied by the imaging strategy used, ranging from a mean of $557 (SD $269) for patients with electroanatomic mapping only to $1,234 (SD $461) for patients with electroanatomic mapping, transesophageal echocardiogram, and computed tomography or magnetic resonance imaging. Mean patient-level imaging expenditures varied by provider (mean $872, SD $249). Periprocedural imaging expenditures also varied by patient risk, with mean expenditures of $862 (SD $444) for patients with a CHADS2 score of ≥2 compared with $907 (SD $466) for CHADS2 score<2 (p<0.001). In conclusion, periprocedural imaging accounts for approximately 6% of mean Medicare expenditures for catheter ablation of AF. The expenditures for periprocedural imaging vary both at the patient and at the provider level and they are inversely related to stroke risk by CHADS2 score.
心血管成像术是房颤（AF）导管消融术程序规划和安全性的重要组成部分。然而，尚未描述房颤导管消融术围手术期成像的成本。本研究利用 2007 年 7 月至 2009 年 12 月间的 Medicare 按服务项目付费数据，评估了房颤导管消融术前后的 Medicare 支出。在 11525 例行房颤导管消融术的患者中，手术当天的总支出平均为 14455 美元（标准差为 7441 美元）。在围手术期内，即包括导管消融前 30 天和消融当天，影像检查的平均支出为 884 美元（标准差为 455 美元）。围手术期影像检查支出因所使用的影像策略而异，从仅使用电生理标测的患者的平均 557 美元（标准差 269 美元）到同时使用电生理标测、经食管超声心动图、计算机断层扫描或磁共振成像的患者的 1234 美元（标准差 461 美元）。平均患者水平的影像支出因提供者而异（平均 872 美元，标准差 249 美元）。围手术期影像支出也因患者风险而异，CHADS2 评分≥2 的患者的平均支出为 862 美元（标准差 444 美元），而 CHADS2 评分<2 的患者为 907 美元（标准差 466 美元）（p<0.001）。总之，围手术期影像占房颤导管消融术 Medicare 支出的 6%左右。影像支出在患者和提供者两个层面都存在差异，且与 CHADS2 评分所代表的卒中风险呈反比。
