National trends and in-hospital costs of atrial fibrillation ablation by energy source in Japan: Insights from the JROAD-DPC nationwide database

Abstract

Background: The economic burden of atrial fibrillation (AF) ablation is growing, yet real-world cost differences by energy source remain unclear. This study aimed to evaluate national trends and in-hospital costs associated with different AF ablation energy sources in Japan.

Methods: We analyzed JROAD-DPC data from April 2017 to March 2023. Patients undergoing AF ablation were categorized by energy source: radiofrequency (RF), cryothermal (Cryo), or hot/laser balloon. The primary outcome was total in-hospital cost per procedure. In-hospital complications were assessed as secondary outcomes.

Results: Among 315,818 patients, 74.6 % received RF ablation, 23.1 % Cryo, and 2.2 % hot/laser balloon. Mean total costs were US$17,181 for RF, US$19,460 for Cryo, and US$18,179 for hot/laser balloon. Differences were mainly driven by material cost, while miscellaneous costs remained similar across groups. Cryo and hot/laser balloon use, higher catheter number, longer hospital stay, and complications contributed to increased total cost. Higher institutional volume and bed capacity were associated with lower cost. Stroke and thromboembolic events were relatively more frequent in the hot/laser balloon group, although overall complication rates were low.

Conclusions: Cryo and hot/laser balloon ablation were associated with higher in-hospital costs than RF, primarily due to device-related expenditures. These findings may support future policy and procedural planning.

Keywords: Atrial fibrillation ablation; Energy source; In-hospital cost; JROAD.