A cost-consequence analysis comparing three cardiac ablation strategies for the treatment of paroxysmal atrial fibrillation

Figures & data

Table 1. Resource consumption real-world analysis: baseline characteristics of the cohort.

Baseline characteristics	ALL (N = 91)	PFA (N = 31)	RFA (N = 30)	CRYO (N = 30)	p-value*
Age (years), mean ± SD	64.0 ± 10.2	64.1 ± 9.9	63.8 ± 11.1	64.0 ± 9.9	0.983
Proportion of male, N (%)	51 (56.0%)	16 (51.6%)	19 (63.3%)	16 (53.3%)	0.612
History of stroke, N (%)	9 (9.9%)	2 (6.5%)	4 (13.3%)	3 (10.0%)	0.667
History of coronary artery disease, N (%)	14 (15.4%)	3 (9.7%)	6 (20.0%)	5 (16.7%)	0.521
Number of treated PV, mean ± SD	4.0 ± 0.2	4.0 ± 0.0	4.0 ± 0.0	3.9 ± 0.3	0.124
Treatment with AAD, N (%)	72 (79.1%)	21 (67.7%)	29 (96.7%)	22 (73.3%)	0.013
Type of anesthesia, N Sedation General anesthesia	61 (67.0%) 30 (33.0%)	21 (67.7%) 10 (32.3%)	20 (66.7%) 10 (33.3%)	20 (66.7%) 10 (33.3%)	0.995

*ANOVA test.

AAD, antiarrhythmic drugs; CRYO, cryoablation; PFA, pulsed field ablation; PV, pulmonary vein; RFA, radiofrequency ablation; SD, standard deviation.

Table 2. Resource consumption real-world analysis: procedural time and healthcare professional workload by phase and treatment option.

Time, mean ± SD	PFA	RFA	CRYO	p-value**
Procedural time by phase
Pre-procedure, min	13.6 ± 3.7	20.4 ± 6.4	18.8 ± 6.6	<0.001
Skin-to-skin, min	50.9 ± 22.4	140.2 ± 82.4	74.5 ± 24.5	<0.001
Post-procedure, min	15.1 ± 5.2	20.5 ± 7.0	16.8 ± 5.8	0.003
Total, min	79.6 ± 20.4	181.2 ± 77.6	110.2 ± 21.0	<0.001
Professional workload*
Physician, min	79.9 ± 32.7	171.0 ± 65.4	127.7 ± 38.0	<0.001
Nurse, min	91.3 ± 36.2	176.4 ± 71.0	124.0 ± 45.2	<0.001
Technician, min	65.3 ± 60.5	196.2 ± 257.1	111.5 ± 108.6	0.009
Anesthetist, min	43.8 ± 39.0	110.1 ± 105.3	57.6 ± 43.8	0.001
Total, min	280.3 ± 109.9	653.3 ± 474.4	426.2 ± 163.5	<0.001

*Sum of the time spent by all the physicians/nurses/technicians/anesthetists involved in the procedure (if N > 1). **ANOVA test.

CRYO, cryoablation; HCP, healthcare professionals; PFA, pulsed field ablation; RFA, radiofrequency ablation; SD, standard deviation.

Table 3. Total costs for a cohort of 100 patients

	PFA	CRYO	RFA
Index hospitalization, EUR	174,143	222,244	265,902
Redo procedures, EUR	24,032	33,781	51,851
Complications, EUR	18,361	45,485	28,840
Total, EUR (95% CrI)	216,535 (198,881; 232,640)	301,510 (276,058; 328,243)	346,592 (318,680; 374,575)

CRYO, cryoablation; PFA, pulsed field ablation; RFA, radiofrequency ablation; CrI, credible intervals; EUR, Euro.

Figure 1. Decision tree structure for the cost-consequence analysis

*Includes costs on procedural time, administered drugs, exams, and length of stay.

CRYO, cryoablation; PFA, pulsed field ablation; RFA, radiofrequency ablation.

Figure 2. Total cost per patient of the cardiac ablation procedure by treatment option

CRYO, cryoablation; PFA, pulsed field ablation; RFA, radiofrequency ablation.

Figure 3. Boxplot of total cost per patient. Each box represents the interquartile range of the total patient cost. The median value is indicated by the line inside each box, with whiskers extending above and below the box. Outliers are shown as individual points

Figure 4. Scenario analysis: total cost difference vs. possible price differences between PFA vs. CRYO and RFA kit

CRYO, cryoablation; PFA, pulsed field ablation; RFA, radiofrequency ablation.

Figure 5. Tornado plot showing results of the one-way sensitivity analysis