Abstract
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.
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.
| Original language | English |
|---|---|
| Article number | euag039 |
| Number of pages | 29 |
| Journal | Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology |
| Early online date | 10 Mar 2026 |
| DOIs | |
| Publication status | E-pub ahead of print - 10 Mar 2026 |
Bibliographical note
© The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.Data Access Statement
The datasets generated and analysed during the current study are not publicly available due to confidentiality agreements and the qualitative nature of the data, which include personal professional opinions expressed during interviews. To protect participant anonymity, full transcripts and audio recordings cannot be shared. Summarized or aggregated data supporting the findings of this study are available from the corresponding author upon reasonable request.UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
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SDG 3 Good Health and Well-being
Keywords
- Europe
- catheters
- value-based healthcare
- innovation
- electrophysiology
- health systems
- public procurement
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