Cost Effectiveness of Antiarrhythmic Medications in Patients Suffering from Atrial Fibrillation

Abstract

Atrial fibrillation (AF), a supraventricular tachycardia disorder, is the most common sustained cardiac arrhythmia affecting 1–2 % of the general population. Prevalence is highly related to age, with every fourth individual older than 40 years old developing AF during his lifetime. Due to an aging population, the prevalence of AF is estimated to at least double within the next 50 years. This article presents AF-related cost-of-illness studies and reviews 19 cost–effectiveness studies and six cost studies published roughly over the past decade, which have compared different antiarrhythmic medications for AF. A systematic literature search for studies published between June 2000 and December 2011 was conducted in PubMed using the combination of keywords ((atrial fibrillation OR atrial flutter) AND cost). Current cost–effectiveness analyses of dronedarone and the pill-in-the-pocket strategy are subject to substantial uncertainties with regard to clinical benefit. Comparing rate control with rhythm control, a cost–effectiveness advantage for rate control was shown in several but not all studies. Within antiarrhythmic drug treatments, magnesium added onto ibutilide was shown to be more cost effective than ibutilide alone. Comparing chemical and electrical cardioversion, the latter was recommended as more cost effective from the healthcare system perspective in all reviewed studies but one. Catheter ablation appeared more cost effective than antiarrhythmic drugs in the medium to long run after 3.2–63.9 years. Admissions to hospital, inpatient care and interventional procedures as well as mortality benefit are key drivers for the cost effectiveness of AF medications. No clear cost–effectiveness advantage emerged for one specific antiarrhythmic drug from the studies that compared antiarrhythmic agents. Rate control as well as catheter ablation appear more cost effective than rhythm control in the treatment of AF. Rate control treatment also seems more cost effective than electrical cardioversion in AF patients.

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Acknowledgments

No sources of funding were used to prepare this article. The authors have no conflicts of interest that are directly relevant to its content and the opinions expressed are those of the authors. Bernd Brüggenjürgen acts as guarantor for the overall content of this article.

Author Contributions

BB and SW had the idea for the paper. BB, SW and TR designed the study and NE, SK and TR conducted the literature search. BB, NE and SK analysed and interpreted the data. BB, NE and SK drafted the manuscript. All authors reviewed the manuscript and participated in the interpretation of results. All authors have read and approved the final submitted version of the article.

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Brüggenjürgen, B., Kohler, S., Ezzat, N. et al. Cost Effectiveness of Antiarrhythmic Medications in Patients Suffering from Atrial Fibrillation. PharmacoEconomics 31, 195–213 (2013). https://doi.org/10.1007/s40273-013-0028-7

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Keywords

  • Atrial Fibrillation
  • Amiodarone
  • Catheter Ablation
  • Sotalol
  • Flecainide