Catharina Hospital, Eindhoven, the Netherlands.
CCB - Medizinisches Versorgungszentrum Frankfurt und Main-Taunus GbR, Frankfurt, Germany.
J Med Econ. 2024 Jan-Dec;27(1):826-835. doi: 10.1080/13696998.2024.2369433. Epub 2024 Jul 1.
Cardiac ablation is a well-established method for treating atrial fibrillation (AF). Pulsed field ablation (PFA) is a non-thermal therapeutic alternative to radiofrequency ablation (RFA) and cryoballoon ablation (CRYO). PFA uses high-voltage electric pulses to target cells. The present analysis aims to quantify the costs, outcomes, and resources associated with these three ablation strategies for paroxysmal AF.
Real-world clinical data were prospectively collected during index hospitalization by three European medical centers (Belgium, Germany, the Netherlands) specialized in cardiac ablation. These data included procedure times (pre-procedural, skin-to-skin and post-procedural), resource use, and staff burden. Data regarding complications associated with each of the three treatment options and redo procedures were extracted from the literature. Costs were collected from hospital economic formularies and published cost databases. A cost-consequence model from the hospital perspective was built to estimate the impact of the three treatment options in terms of effectiveness and costs.
Across the three centers, = 91 patients were included over a period of 12 months. A significant difference was seen in pre-procedural time (mean ± SD, PFA: 13.6 ± 3.7 min, CRYO: 18.8 ± 6.6 min, RFA: 20.4 ± 6.4 min; < .001). Procedural time (skin-to-skin) was also different across alternatives (PFA: 50.9 ± 22.4 min, CRYO: 74.5 ± 24.5 min, RFA: 140.2 ± 82.4 min; < .0001). The model reported an overall cost of €216,535 per 100 patients treated with PFA, €301,510 per 100 patients treated with CRYO and €346,594 per 100 patients treated with RFA. Overall, the cumulative savings associated with PFA (excluding kit costs) were €850 and €1,301 per patient compared to CRYO and RFA, respectively.
PFA demonstrated shorter procedure time compared to CRYO and RFA. Model estimates indicate that these time savings result in cost savings for hospitals and reduce outlay on redo procedures. Clinical practice in individual hospitals varies and may impact the ability to transfer the results of this analysis to other settings.
心脏消融术是治疗心房颤动（AF）的一种成熟方法。脉冲场消融（PFA）是一种替代射频消融（RFA）和冷冻球囊消融（CRYO）的非热治疗方法。PFA 使用高压电脉冲来靶向细胞。本分析旨在量化这三种消融策略治疗阵发性 AF 的成本、结果和资源。
通过三家专门从事心脏消融的欧洲医疗中心（比利时、德国、荷兰），前瞻性地在索引住院期间收集真实世界的临床数据。这些数据包括手术时间（术前、皮肤到皮肤和术后）、资源使用情况和员工负担。从文献中提取与三种治疗选择和重复程序相关的并发症数据。从医院经济表格和已发布的成本数据库中收集成本。从医院角度构建了一个成本-后果模型，以根据有效性和成本评估三种治疗选择的影响。
在三个中心，在 12 个月的时间内共纳入了 91 名患者。在术前时间（平均值±标准差，PFA：13.6±3.7 分钟，CRYO：18.8±6.6 分钟，RFA：20.4±6.4 分钟；<.001）方面观察到显著差异。手术时间（皮肤到皮肤）在替代方案之间也不同（PFA：50.9±22.4 分钟，CRYO：74.5±24.5 分钟，RFA：140.2±82.4 分钟；<.0001）。模型报告了每 100 例接受 PFA 治疗的患者的总成本为 216,535 欧元，每 100 例接受 CRYO 治疗的患者的总成本为 301,510 欧元，每 100 例接受 RFA 治疗的患者的总成本为 346,594 欧元。总体而言，与 CRYO 和 RFA 相比，PFA（不包括试剂盒成本）每例患者可节省 850 欧元和 1,301 欧元。
与 CRYO 和 RFA 相比，PFA 显示出较短的手术时间。模型估计表明，这些时间节省为医院节省了成本，并减少了重复程序的支出。个别医院的临床实践各不相同，这可能会影响将本分析结果转移到其他环境的能力。
