A cost comparison of cryoballoon ablation and pulsed field ablation with a pentaspline catheter: 1 year cost outcomes from the English NHS perspective

Abstract Background Technological advances in atrial fibrillation (AF) ablation have improved procedural safety and patient outcomes over the past two decades. Whist novel technologies may offer the promise of improved outcomes with reduced complications, it is important to evaluate them against established therapies. Pulsed-field ablation (PFA) with a pentaspline catheter is the first single-shot PFA catheter approved for use in the European market. The most established single-shot technology for ablation of AF is the cryoballoon. Purpose To compare cost outcomes of the established cryoballoon system versus the PFA pentaspline in patients undergoing AF ablation from the English National Health Service (NHS) perspective. Methods A cost-comparison was undertaken with a one-year time horizon for a population who underwent cryoballoon ablation for AF from April 2023 to March 2024 using Hospital Episode Statistics NHS Digital data. Patients could have an ablation with either the cryoballoon or PFA. Adverse events (AE), freedom from arrhythmia and repeat ablations were sourced from recently published comparative studies and the National Institute for Health and Care Excellence (NICE) AF guidelines (NG196). Unit costs were based on the NG196 and NHS reference costs (Table 1). The cost of the ablation procedure was calculated using the unit price for a day case from the 2024/25 NHS prices workbook, both with and without the cost of the catheters. Model input uncertainty was explored using deterministic sensitivity analysis. Results Over one year, treating patients with the cryoballoon catheter saved £144 per patient compared to the PFA pentaspline catheter, excluding catheter costs. Including catheter costs, savings increased to £1,885 per patient (Table 2). The primary driver in the base case was freedom from AF and fewer repeat ablations, as the group with higher AF freedom rate had lower costs related to repeat ablation. This was followed by AEs as the second key driver. When catheter costs were included, this became the main driver of savings. In all scenarios, cryoballoon ablation remained cost-saving (Table 2). Conclusion The outcomes of the cost-comparison without the price of the catheters demonstrates that the established cryoballoon system remains a viable clinical and economic option, highlighting that its lower price is not the sole reason for considering cryoablation as a treatment compared to the PFA pentaspline. These financial benefits increased when catheter costs were included in the evaluation. Further evidence and economic analysis are needed to assess costs over a longer period and cost differences among the various PFA catheters available.Table 1.Clinical and Cost Inputs Table 2.Results