Improving the payment methods for high-tech treatment of atrial fibrillation in the Russian Federation

Objective. To develop the recommendations for improving payment methods for radiofrequency ablation of accessory pathways and arrhythmogenic zones of the heart with and without cardiac mapping navigation system. Material and methods. We analyzed national guidelines and current payment system for high-tech medical care in cardiovascular surgery. Standard costs for RFA with and without navigation mapping systems were calculated using technological maps incorporating labor costs, medications, equipment depreciation, and medical supplies. Costs were derived from weighted average data in the Russian State Procurement Unified Information System. Alternative payment models and proposals for improving provider-payment policy were developed. Results. Current national guidelines underline high efficacy of RFA combined with antiarrhythmic therapy. Such combination can reduce mortality by 26.5% and admission rate by 10.4%. However, the existing payment model under the State Guarantee Program for 2025—2027 does not specify visualization methods or ablation types that leads to significant economic imbalance. The calculated cost of a case using RFA with 3D navigation mapping is 831.524.43 RUB that is 2.7 times higher than the established standard cost (306.509 RUB). Nosological, methodological and combined approaches to payment methods were proposed, and the latest was identified as the most appropriate. Within current number of cases (54.355 annually) and percentage of navigation-based mapping (23%), reclassifying this technology into a separate high-tech care group would require additional funding ~6.56 billion RUB. Conclusion. Current reimbursement rates for endovascular interventions in patients with heart rhythm disorders do not cover the demand, do not account for emergence and adoption of new techniques, including those involving navigation mapping, and have to be improved with the aforementioned approaches.