Cost-consequence analysis of three cardiac ablation technologies in paroxysmal atrial fibrillation

Background and aim: The rapid evolution of catheter ablation technologies has introduced variability in clinical outcomes, procedural efficiency, and costs. This study aimed to evaluate the economic costs and clinical outcomes associated with radiofrequency ablation (RFA), cryoablation (CRYO), and pulsed field ablation (PFA) for the treatment of paroxysmal atrial fibrillation (AF). Methods: A cost-consequence analytical model was developed to assess the economic impact and clinical outcomes of three treatment alternatives for adult patients with paroxysmal AF, from the hospital's perspective, in the short (index hospitalization) and medium-term (1 year). Real-world data were collected across three European specialty centers (Czech Republic, Italy, and Spain). The collected data captured procedural durations (including pre-procedural, skin-to-skin, and post-procedural phases), resource consumption, and staff workload. Costs were retrieved from institutional economic databases and published cost repositories. Costs were expressed in Euro (2025). Medium-term outcomes (complications, reinterventions, hospitalizations, cardioversions) were sourced from literature. Results: A total of N = 270 patients were included in the analysis. PFA was associated with consistency and predictable procedure duration compared to the other treatment alternatives. This efficiency may support increased capacity within the healthcare systems. PFA demonstrated cost saving of 10% compared to CRYO and 22% compared to RFA procedures, primarily driven by procedure time. Additionally, PFA showed a cost per responder of €2,406, versus €2,873 for CRYO (+19%) and €3,436 for RFA (+43%), reflecting both lower procedural costs and superior clinical outcomes. Conclusion: These findings suggest that PFA technology may offer economic and operational advantages, including more efficient resource utilization, reduced procedural complexity and consumables use, compared to traditional ablation modalities. However, variations in hospital clinical practices may limit the generalizability of results.