Biosense Webster – Health Economics & Outcomes Research

Retrospective Database Studies

Using state-of-the-art medical databases, Biosense Webster, Inc. outcomes research advances our understanding of the treatment of heart rhythm disorders to improve patient outcomes.

Retrospective Database Studies

The Use of Intracardiac Echocardiography (ICE) Catheters in Endocardial Ablation of Cardiac Arrhythmia: Meta-Analysis of Efficiency, Effectiveness, and Safety Outcomes 

Goya, Masahiko, et al.  J Comp Eff Res. January 2020. doi: 10.1111/jce.14367 

retrospective database studies objective 1

Objective

Compare use of ICE during catheter ablation of cardiac arrhythmias affect outcomes compared to ablation without the use of ICE

retrospective database studies method 1

Methods

  • Systematic literature review and meta-analysis
  • 19 studies identified
  • 2,186 total patients included
retrospective database studies results 1

Results

Use of ICE was associated with a significant:

  • 6.95 mean reduction in fluoroscopy time
  • 15.2 mean reduction in procedure time
  • Reduction in fluoroscopy dose

Predictors of Cardiac Perforation with Catheter Ablation of Atrial Fibrillation

Friedman, Daniel, et al. JACC EP. March 2020. DOI:10.1016/j.jacep.2020.01.011 

retrospective database studies objective 2

Objective

Identify factors associated with the occurrence of cardiac perforation caused during a catheter ablation procedure for atrial fibrillation

retrospective database studies method 2

Methods

  • Retrospective, observational cohort study 

  • Data from the Medicare Standard Analytic File was used 

  • Logistic regression was used to assess predictors of cardiac perforation 

retrospective database studies results 2

Results

  • 1.3x greater odds of perforation for female sex
  • 1.4x greater odds of perforation for obesity
  • 4.9x lower odds of perforation with use of ICE
  • 0.1x lower odds of perforation with prior cardiac surgery

Real-world Outcomes of Ventricular Tachycardia Catheter Ablation with Versus Without Intracardiac Echocardiography 

Field ME, Gold MR, Reynolds MR, et al. J Cardiovasc Electrophysiol. 2019 Dec 23 doi:10.1111/jce.14324

retrospective database studies objective 3

Objective

Assess differences in outcomes between ventricular tachycardia (VT) patients undergoing catheter ablation with versus without the use of intracardiac echocardiography (ICE)

retrospective database studies method 3

Methods

  • Retrospective, observational cohort study
  • Data from the IBM MarketScan Commercial and Medicare Supplemental databases were used
  • Comparison using propensity-score matching and regression analysis
retrospective database studies results 3

Results

As compared to the non-ICE cohort, at 12-month follow-up, the ICE cohort was associated with:

  • 24% lower odds of VT-related readmission
  • 30% lower odds of repeat VT ablation

Catheter Ablation of Atrial Fibrillation with and Without On-Site Cardiothoracic Surgery 

Friedman, Daniel J et al. J Am Coll Cardiol. 2019 May 21. doi:10.1016/j.jacc.2019.02.036

retrospective database studies objective 4

Objective

Assess the relationship between the presence or absence of on-site cardiothoracic surgery (CTS) units, with 30-day rates of cardiac perforation, CTS, re-hospitalization, and death

retrospective database studies method 4

Methods

  • Retrospective, non-randomized database study
  • Data from the Medicare Standard Analytic File was used
  • Comparison using propensity-score matching and regression analysis
retrospective database studies results 4

Results

There was no significant difference between the presence or absence of CTS units and rates of cardiac perforation, CTS, re-hospitalization, and death

Economic impact of atrial fibrillation ablation with radiofrequency contact force catheter versus cryoballoon catheter 

Pollak SJ, Goldstein L, Daskiran M, Kalsekar I, Khanna R. J Comp Eff Res. March 2019. doi:10.2217/cer-2018-0112 

retrospective database studies objective 5

Objective

Compare health utilization among atrial fibrillation patients undergoing ablation with a contact force-sensing catheter (CF) versus a cryoballoon (CB) catheter

retrospective database studies method 5

Methods

  • Retrospective, observational database study 

  • Data from the Premier Healthcare Database was used 

  • Comparison using propensity-score matching and regression analysis 

retrospective database studies results 5

Results

Primary analysis showed that compared to CB catheters, ablation with CF catheters was associated with:  

  • Lower total index ablation costs and lower total supply costs 

  • Lower odds of all-cause inpatient readmissions and lower odds of cardiovascular-related inpatient readmission 

Resource Use and Clinical Outcomes in Patients with Atrial Fibrillation with Ablation versus Antiarrhythmic Drug Treatment 

Jarman JWE, Hussain W, Wong T, et al. BMC Cardiovasc Disord. 2018 Nov 7. doi:10.1186/s12872-018-0946-6 

retrospective database studies objective 6

Objective

Examine the long-term differences in outcomes between catheter ablation and anti-arrhythmic drug (AAD) treatment for atrial fibrillation 

retrospective database studies method 6

Methods

  • Retrospective, longitudinal database study 
  • Data from the UK Clinical Practice Research Database linked with Hospital Episode Statistics was used 
  • Comparison using propensity-score matching and regression analysis 

retrospective database studies results 6

Results

  • At one-year follow-up, catheter ablation was associated in a significant reduction in outpatient CV visits compared to AAD patients  

  • At three-year follow-up, patients receiving ablation had significant reductions in heart failure, reduced mortality and lower incidences of the composite outcome compared to AADs 

Comparison of real-world clinical and economic outcomes between the ThermoCool® SF and ThermoCool® catheters in patients undergoing radiofrequency catheter ablation for atrial fibrillation 

Chinitz L, Goldstein LJ, Barnow A, et al. Clinicoecon Outcomes Res. 2018 Oct 4. doi:10.2147/CEOR.S180125 

retrospective database studies objective 7

Objective

Evaluate the real-world clinical and economic outcomes associated with the use of the ThermoCool® Surround Flow (SF) and ThermoCool® catheters in atrial fibrillation ablation

retrospective database studies method 7

Methods

  • Retrospective, observational database study 

  • Data from the Premier Healthcare Database was used 

  • Multivariable-adjusted regression analysis to compare clinical and cost outcomes 

retrospective database studies results 7

Results

  • No significant differences in mean total costs and mean supply cost between groups despite the price premium of the THERMOCOOL® SF catheter 

  • At 12-months, the THERMOCOOL® SF group has significantly fewer all-cause readmissions, cardiovascular-related readmissions and direct current cardioversions 

Cost Comparison of Radiofrequency Catheter Ablation Versus Cryoablation for Atrial Fibrillation in Hospitals Using Both Technologies 

Hunter TD, Palli SR, Rizzo JA. J Med Econ. Oct 2016. doi:10.1080/13696998.2016.1187153 

retrospective database studies objective 8

Objective

Compare the cost of radiofrequency (RF) ablation vs. cryoablation (Cryo) in atrial fibrillation (AF) patients 

retrospective database studies method 8

Methods

  • Retrospective, observational cohort study 

  • Data from the Premier Healthcare Database was used  

  • Patients were sorted into three cohorts (RF, Cryo Only, Cryo and RF) and compared using regression analysis 

retrospective database studies results 8

Results

  • Cryo was $2,803 (30.0%) higher on average for inpatient ablation procedures compared to RF 

  • Cryo was $2,215 (19.5%) higher on average for outpatient ablation procedures compared to RF 

  • Almost 40% of the Cryo cases required additional RF catheter use 

Use of the THERMOCOOL SMARTTOUCH catheter for ablation of atrial fibrillation: the relationship between hospital procedure volume, readmissions, and economic outcomes 

Barnow A, Goldstein L, Kalsekar I, Liao R, Khanna R. J Med Econ.May 2018;. doi:10.1080/13696998.2018.1423566 

retrospective database studies objective 9

Objective

Examine the relationship between hospital volume of prior THERMOCOOL® SMARTTOUCH catheter use and health economic outcomes for atrial fibrillation (AF) patients undergoing ablation using this device 

retrospective database studies method 9

Methods

  • Retrospective, observational cohort study 

  • Data from the Premier Healthcare Database was used  

retrospective database studies results 9

Results

An increase of hospital volume of prior THERMOCOOL® SMARTTOUCH catheter use was associated with decreases in mean length-of-stay and 12-month all-cause readmissions

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