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Cost-effectiveness analysis of dronedarone versus other anti-arrhythmic drugs for the treatment of atrial fibrillation—results for Canada, Italy, Sweden and Switzerland

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Abstract

The ATHENA clinical trial enrolled 4,628 patients in 37 countries and evaluated the efficacy of dronedarone 400 mg twice daily versus placebo for the prevention of cardiovascular hospitalisation or death from any cause in patients with paroxysmal or persistent atrial fibrillation or atrial flutter. The trial showed a statistically significant 24 % reduction in the primary endpoint cardiovascular hospitalisations or all-cause death. In the current paper, parameters that drive the cost-effectiveness of dronedarone on top of standard therapy versus likely comparators, i.e. amiodarone, sotalol and flecainide, were investigated by means of a health economic model based on the ATHENA clinical trial. Dronedarone is cost-effective, and ICERs are low versus amiodarone with €5,340; €4,620; €3,850 and €5,630 per QALY gained for Canada, Italy, Sweden and Switzerland, respectively. The most significant driving factor for the cost-effectiveness of dronedarone is the increased survival rate for patients on dronedarone.

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Abbreviations

AAD:

Antiarrhythmic drug

ACS:

Acute coronary syndrome

AE:

Adverse events

AF:

Atrial fibrillation

AFL:

Atrial flutter

CAD:

Coronary artery disease

CHADS2 :

Score estimating the risk of stroke and based on the condition of the patient regarding CHF, hypertension, age, diabetes mellitus, prior stroke or TIA

CHF:

Congestive heart failure

CV:

Cardiovascular

ICER:

Incremental cost-effective ratio

LVEF:

Left ventricular ejection fraction

LYG:

Life year gained

MTC:

Mixed treatment comparison

QALY:

Quality adjusted life-year

SHD:

Structural heart disease

TIA:

Transient ischemic attack

MSE:

Main safety endpoint

SOC:

Standard of care

SPC:

Summary of product characteristics

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Acknowledgments

This study was funded by Sanofi-Aventis.

Conflict of interest

J.N., Ö.Å. and P.L. are employees of a clinical research organization (CRO) having Sanofi-Aventis as a client. G.B.B. is a Sanofi-Aventis employee. M.R. is a clinical expert in cardiology from Södersjukhuset in Sweden.

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Authors and Affiliations

  1. OptumInsight, Klarabergsviadukten 90D, Hus D, 111 64, Stockholm, Sweden

    Jonas Nilsson, Örjan Åkerborg & Peter Lindgren

  2. Sanofi-Aventis, Massy, France

    Gaëlle Bégo-Le Bagousse

  3. Kardiologiska kliniken, Södersjukhuset AB, Stockholm, Sweden

    Mårten Rosenquist

  4. Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden

    Peter Lindgren

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  1. Jonas Nilsson
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  3. Gaëlle Bégo-Le Bagousse
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Correspondence to Jonas Nilsson.

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Nilsson, J., Åkerborg, Ö., Bégo-Le Bagousse, G. et al. Cost-effectiveness analysis of dronedarone versus other anti-arrhythmic drugs for the treatment of atrial fibrillation—results for Canada, Italy, Sweden and Switzerland. Eur J Health Econ 14, 481–493 (2013). https://doi.org/10.1007/s10198-012-0391-x

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