Carbon footprint of catheter ablation versus anti-arrhythmic drug therapy in atrial fibrillation: a pilot ecological cost-effectiveness estimation

Atrial fibrillation (AF) is the most prevalent arrhythmia in the general population between 2 and 4%. Catheter ablation of AF has been developed since the 2000s and has shown a high efficiency. In consequence, catheter ablation of AF has steadily increased over the last 20 years. Based on an estimation of 600 000 AF ablations every year, it represents a procedure every minute, and this amount is rapidly increasing as AF incidence grows worldwide. Consequently, its economic impact is very important in the health systems of developed countries. Its cost is estimated to be around 1% of the total public health expenditure of a country like the UK. The cost-effectiveness of ablation has been studied in numerous studies, concluding that it represents an economically viable treatment in spite of a significant additional cost compared to drugs alone.

Although the economic cost of our health needs is an important issue, global warming and its dramatic consequences are a major challenge for our societies. Paradoxically, the healthcare sector is one of the biggest contributors of greenhouse (GHG) emission. It is estimated to account for 5% of global GHG emission and up to 10% in the developed countries. Studying the ecological impact of the health care system would help decision-makers to guide policies toward a more sustainable system. Yet, environmental studies in medicine are scarce. Eco-audit is a powerful tool to determine the GHG emission during the different phases of a product life. This method has recently been applied to study AF catheter ablation: AF catheter ablation involves a mean of 76.9 kg of CO2-e. With an estimated 600 000 annual worldwide procedures, the environmental impact of AF catheter ablation activity is estimated equal to 125 tons of CO2 emission each day.  
The main goal of this project is to accurately and uniformly assess the carbon footprint of the various diagnostic and therapeutic strategies we use in AF patients. A second step would be to evaluate, as it is done in the economic sector, a ratio between the carbon footprint and the gain for the patient of the different strategies used. We will compare ablation strategy to pharmacological strategy, assessing the ratio between the carbon footprint of an atrial fibrillation ablation strategy versus drug therapy and its medical benefit.

The evaluation of the ecological cost of the 2 different strategies will consider consultations, hospitalisations, diagnostic tests, pharmacological and invasive treatment. Data sources used to populate the parameters within this model included a combination of real‐world evidence studies and randomised trials. These were derived from: (1) a systematic literature review and meta‐analysis of randomised controlled trials for AF recurrence; (2) targeted searches of published literature for utilisation, cardiovascular event rates, and utility, focusing on real‐world AF populations and long‐term follow‐up.

 

Supervisors: Benjamin Jacques Mar Casteigt (Hospital del Mar), Oscar Camara (DTIC)