Economic evaluation of a large-focal lattice tip catheter versus conventional radiofrequency catheter, for persistent atrial fibrillation ablation, from a German healthcare payer perspective

Background Growing number of atrial fibrillation (AF) patients, limited resources and budget constraints are some of the key challenges the German healthcare system is facing. In this environment, economic evaluation of new and existing technologies has become increasingly important. In patients with atrial fibrillation (AF), the use of pulsed field ablation (PFA), is steadily increasing compared to conventional thermal ablation technologies. However, in Germany, there is limited evidence evaluating the economic impact of PFA. Purpose To assess the cost-effectiveness of a large-focal lattice tip (LFLT) pulsed field and radiofrequency mapping and ablation catheter compared to a conventional contact-force sensing radiofrequency ablation catheter (CFRF), for the treatment of persistent atrial fibrillation patients (PersAF), from a German healthcare service payer perspective. Methods The cost-effectiveness model (CEM) consisted of a decision tree for the first year and a Markov model with a three-month cycle length for the remaining lifetime horizon (40 years). Individual patient level data from SPHERE Per-AF randomized controlled study (RCT, NCT05120193) were utilized to estimate key CEM parameters, including efficacy, safety and resource use in symptomatic PersAF patients. When trial data could not provide certain model parameters, inputs were sourced from published literature. Cost inputs were derived from diagnosis-related groups provided by the German Institute for the Hospital Remuneration System (InEK). Health benefits were expressed in quality-adjusted life years (QALYs). Costs and benefits were discounted at 3% annually. Input model uncertainty was explored with sensitivity and scenario analysis. Results Large-focal lattice tip catheter ablation was estimated to be dominant, less costly while producing higher health benefits, compared to CFRF (Table 1). LFLT ablation accrued less costs (-€6,458) and more QALYs (0.07). The lifetime average cost per patient was €12,469 for LFLT and €18,927 for CFRF; the average QALY per patient was 9.51 for LFLT and 9.44 for CFRF. A lower arrhythmia recurrence and fewer repeat ablations in the LFLT arm were the key drivers of the results. LFLT remained cost-saving through all scenario analyses (Table 2). Conclusion The large-focal lattice tip catheter is a cost-saving treatment for PersAF patients from a German healthcare service payer perspective.