Economic evaluation of two pulsed field ablation systems, a conformable large-lattice catheter versus a pentaspline catheter, for the treatment of paroxysmal atrial fibrillation
S Ahsan, M Kalla, P Neuzil, E Ismyrloglou, W Mburu, F Kueffer, M Souter, G RackauskasAbstract
Background
Technological advancements in atrial fibrillation (AF) ablation have greatly improved procedural safety and efficacy. Pulsed field ablation (PFA) offers the potential for precise myocardial ablation with minimal collateral damage. Multiple PFA catheter systems are currently available, each differing in design and energy delivery. As PFA adoption grows, understanding the economic impact of each system becomes increasingly important. This study evaluates the economic implications of the conformable 34mm large-lattice (CLL) PFA catheter compared to the pentaspline PFA catheter within the English National Health Service (NHS) hospital setting, aiming to inform evidence-based decision-making and optimize resource utilization.
Purpose
To examine the economic value of the CLL PFA catheter compared to the pentaspline PFA catheter for the treatment of paroxysmal AF from the NHS perspective.
Methods
The economic analysis was based on arrhythmia recurrence, repeat ablations and safety rates. In the absence of head-to-head studies, matching-adjusted indirect comparison (MAIC) was implemented to compare efficacy outcomes from the first-in-human studies of both the CLL PFA catheter and the pentaspline PFA catheter. MAIC analysis was done in both the total and optimized cohorts. A cost comparison based on these MAIC results was performed with a one-year time horizon. One of the studies reported zero safety event rates and given MAIC cannot be completed with zero event rates, unadjusted safety rates were used for the cost analysis. For repeat ablations, the relative difference in repeat ablation rates derived from the MAIC analysis was applied to the rate reported in the National Institute for Health and Care Excellence (NICE) AF guidelines (NG196). Repeat ablations were assumed to be performed using a radiofrequency (RF) catheter, with associated safety event rates sourced from NG196. Cost estimates of safety events were obtained from NG196 and NHS national cost collection (Table 1). The ablation procedure cost was estimated using the 2024/25 NHS National Cost Collection unit price for a day case. Sensitivity analysis explored input uncertainty.
Results
Treating patients with the CLL resulted in a saving of £950 per patient compared to the pentaspline catheter over one year (Table 2). Key drivers of the cost savings were lower arrhythmia recurrence and fewer repeat ablations. In sensitivity analysis, CLL PFA ablation remained to be cost-saving.
Conclusion
Initial clinical experience suggests that the CLL PFA catheter is cost-saving compared to the pentaspline PFA catheter for the treatment of paroxysmal AF patients, from the NHS perspective. Direct head-to-head studies should be performed to confirm these outcomes.Table 1.Clinical and cost inputsTable 2.Results