Pulsed field ablation with the pentaspline catheter compared with cryoablation for the treatment of paroxysmal atrial fibrillation in the UK NHS: a cost-comparison analysis

• Published in: BMJ open Vol. 14; no. 5; p. e079881
• Main Authors: Duxbury, Claire, Begley, David, Heck, Patrick M
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 09.05.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Ablation; Atrial Fibrillation - economics; Atrial Fibrillation - surgery; Atrial Fibrillation - therapy; Cardiac arrhythmia; Cardiovascular medicine; Catheter Ablation - economics; Catheter Ablation - methods; Catheters; Cost analysis; Cost estimates; Cost-Benefit Analysis; Cryosurgery - economics; Cryosurgery - methods; Decision trees; Electric fields; health economics; Humans; Neurological disorders; pacing & electrophysiology; Patients; State Medicine - economics; therapeutics; Thermal energy; United Kingdom; Veins & arteries; United Kingdom; United Kingdom > UK; United States > US; pacing & electrophysiology; therapeutics; health economics
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-079881

ObjectivesPulsed field ablation (PFA) is a promising new ablation modality for the treatment of atrial fibrillation (AF) that has recently become available in the UK National Health Service (NHS). We provide the first known economic evaluation of the technology.MethodsA cost-comparison model was developed to compare the expected 12-month costs of treating AF using the pentaspline PFA catheter compared with cryoablation for a single hypothetical patient. Model parameters were based on a recent cost-effectiveness analysis by the National Institute for Health and Care Excellence where possible or published literature otherwise. Deterministic sensitivity, scenario and threshold analyses were conducted.ResultsCosts for a single patient treated with PFA were −3% (−£343) less over 12 months than those who received treatment with cryoablation. PFA was associated with 16% higher catheter costs but repeat ablation costs were over 50% less, driven by a reduction in repeat ablations required. Costs of managing complications were −£211 less in total for PFA compared with cryoablation.ConclusionsRoutine adoption of PFA with the pentaspline PFA catheter looks to be as affordable for the NHS as current treatment alternative cryoablation.