Health economic analysis of pulsed field ablation compared to conventional thermal ablation for patients with paroxysmal atrial fibrillation in China.

Aim: To evaluate the cost-utility of pulsed field ablation (PFA) compared with radiofrequency ablation (RFA) and cryoablation, respectively, in Chinese patients with paroxysmal atrial fibrillation. Materials & methods: Patients with paroxysmal atrial fibrillation at different levels of atrial arrhythmia burden (<0.1%, 0.1-9.9%, ≥10%) may experience various atrial arrhythmia burden states after undergoing ablation. A decision tree model was developed to simulate this process from a healthcare perspective, where patients could undergo a repeat ablation or experience a nonfatal stroke. Transition probabilities, clinical outcome and quality of life data were obtained from published sources and confirmed by expert physicians. Cost data were estimated from a survey of clinicians at tertiary hospitals, based on actual clinical practices. The uncertainty of results was explored through one-way sensitivity analysis and probabilistic sensitivity analysis by Monte Carlo simulation. The secondary outcome, return on investment, was calculated from hospital administrator perspective, as net revenue divided by total cost of certain ablation type.

Results

PFA demonstrated favorable cost-effectiveness compared with both RFA and cryoablation under the three-times China's per capita GDP threshold. When compared with RFA, PFA yielded an incremental 0.016 quality-adjusted life years (QALYs) (0.859 vs 0.842) with an incremental cost-effectiveness ratio of ¥37,000 per QALY gained. This cost-effectiveness was primarily driven by savings of ¥1558 in weighted repeat ablation surgery costs and ¥506 in long-term medication costs for anti-arhythmic and anticoagulants. When compared with cryoablation, PFA resulted in an incremental 0.006 QALYs (0.859 vs 0.852) with an incremental cost-effectiveness ratio of ¥231,167 per QALY gained, mainly attributed to savings of ¥1300 in repeat ablation surgery costs and ¥133 in long-term medication costs. As a secondary outcome, PFA yielded a return on investment of 0.313.

Conclusion

PFA was likely to be more cost effective than both radiofrequency ablation and cryoablation in China. The study suggests that PFA represents a high-value intervention that aligns superior clinical outcomes with favorable hospital financial sustainability, supporting its prioritized adoption in the management of atrial fibrillation in China.