Real-world cost comparison of pulsed field ablation versus radiofrequency ablation with thermal protection in atrial fibrillation
V A Sagar, J S Gill, Z Akhtar, A Li, M Norman, Z Zuberi, M Sohal, A Bajpai, L W M Leung, M M GallagherAbstract
Background
Atrial fibrillation (AF) imposes healthcare costs. Radiofrequency ablation (RFA) is a standard treatment. Pulsed field ablation (PFA) is a non-thermal alternative, often favoured for oesophageal safety, but when performed with oesophageal cooling device, RFA is similarly safe. The cost relationship between RFA with cooling and PFA has not been evaluated.
Objective
To compare real-world costs of RFA with oesophageal cooling device compared to pentaspline and circular array PFA in the UK public health setting.
Methods
A cost comparison was conducted for 100 consecutive patients undergoing PFA or RFA for AF at our institute. Total procedure cost (encompassing equipment, staff burden and laboratory time, hospital bed-stay) and complications and readmissions to 90 days were recorded as endpoints and incorporated in costs. The cost of each procedure was calculated using NHS Tariff Costs and compared between three ablation techniques.
Results
Three hundred patients (65±10 years; 68% were male, 53% had persistent AF) underwent ablation: RFA with thermal protection (n=100), Pentaspline (n=100), and Circular array (n=100). Median cost was highest with pentaspline (£12,147; IQR £9,888–£14,192), followed by circular array (£11,326; IQR £11,096-11,503) and RFA (£6,990; IQR £6,637-7,460) (P<0.001). PFA procedures were shorter (Circular Array: 84 min, IQR 63–102; Pentaspline: 100 min, IQR 74–121) versus RFA (178 min, IQR 154–210) (P<0.001). Fluoroscopy time was longer with PFA (Pentaspline: 20 min, IQR 15–26; Circular array: 18 min, IQR 13–23) than RFA (9 min, IQR 6–14) (P<0.001). Major complications occurred in 3% (Pentaspline), 2% (Circular array), and 1% (RFA) (P=0.6).
Conclusion
PFA is about twice as costly as RFA with oesophageal cooling, despite savings arising from faster procedures. More fluoroscopy is used in PFA procedures.Results tableTornado diagram one way analysis