Electrophysiology Consumables Procurement in Europe: Implications for Access, Innovation and Value-Based Care.

Aims To examine and compare public procurement systems for electrophysiology (EP) consumables across 21 European countries, focusing on governance level, evaluation methods, clinician involvement, reimbursement variability, access to innovation and sustainability integration. Methods A qualitative, exploratory design was employed using 22 semi-structured interviews with EP clinicians, procurement specialists and health system stakeholders across 21 countries. Interview transcripts and summaries were thematically coded by two independent researchers using a structured six-domain framework. Results Substantial heterogeneity in procurement practices was identified. Hospital-level procurement predominates in 43% of countries, while 33% use regional-level tenders; a minority operate national-level frameworks. Evaluation methods vary, with several countries using price-driven criteria, while others apply mixed or clinically weighted models. Clinician involvement is high or moderate in two-thirds of countries, but often informal or lacking governance structure. Reimbursement for EP procedures varies widely in scope and transparency, with bundled and global budget models affecting innovation uptake. Innovation access remains uneven: countries such as Austria, the Netherlands and France use innovation funds or dedicated pathways, while others rely on centralized approvals or re-tendering. Sustainability criteria are rarely formalized in procurement decisions, despite growing awareness of environmental impact. Conclusion European procurement systems for EP consumables differ markedly in structure, evaluation practices and alignment with clinical and innovation priorities. Integrating clinician input, adopting value-based frameworks and embedding sustainability metrics could enhance procurement outcomes and patient care. Harmonized guidance from EHRA and EU-level stakeholders may support more equitable and innovation-friendly procurement strategies.