OBJECTIVES: Catheter ablation procedures for Atrial Fibrillation (AF) can be evaluated regarding the possibility of reducing the length of hospital stay. Considering the cryoablation procedures, the hospitalization setting is still widespread in Italy, despite the numerous evidence supporting the day hospital management. This analysis aims to evaluate the variation in resource consumption for the two different hospital pathways.

METHODS: The analysis was conducted in a Southern Italian hospital by using Activity-Based Costing method. Through clinical and administrative staff interviews, data on patient pathway costs and dedicated staff time (per minute) have been collected. An economic valorization allowed the definition of the total costs for each hospital setting. The center shared the unit costs of drugs, imaging, laboratory exams, consumables, medical procedures, and visits, while non-clinical staff and overhead were quantified through literature (discounted costs).The focus was on patient journey costs and not on devices, drugs, and consumables that were used in equal amounts in both care settings.

RESULTS: The population treated had an age of 56 ± 9 years (25.9% were women); most of the patients (75%) suffered from paroxysmal AF, 25% from persistent AF. No peri-procedural events were observed in any patient. The cost difference between the two hospitalization settings (ordinary with two nights and daytime with one night) was found to be €493.23 for each patient. The main cost driver for the path in ordinary hospitalization was represented by the hospital stay, which showed to be 36% of the total.

CONCLUSIONS: Wider adoption of day-hospital cryoablation AF procedures, following careful patient selection, would lead to patient management costs and resource consumption optimization. It would result in the reduction of the length of stay and freeing up of beds (allowing their reallocation where necessary), reduction of waiting lists, and acceleration of patient access to care.