Advertisement

PharmacoEconomics

, Volume 22, Issue 13, pp 877–883 | Cite as

Cost Effectiveness of Ibutilide With Prophylactic Magnesium in the Treatment of Atrial Fibrillation

  • Craig I. Coleman
  • James S. Kalus
  • C. Michael White
  • Anne P. Spencer
  • James P. Tsikouris
  • Jenny O. Chung
  • Kenneth W. Kenyon
  • Martin Ziska
  • Jeffrey Kluger
  • Prabashni Reddy
Original Research Article

Abstract

Background: In the Treatment with Ibutilide and Magnesium Evaluation (TIME) study, a retrospective multicentre cohort trial, prophylactic magnesium was found to improve the antiarrhythmic efficacy of ibutilide as demonstrated by an increase in the rate of successful chemical conversion and reduction in the need for direct current cardioversion (DCC).

Objective: The primary objective of this piggyback cost-effectiveness analysis of the TIME study was to compare the cost per successful conversion of atrial fibrillation (AF) for ibutilide in the presence and absence of magnesium prophylaxis. A secondary objective was to determine whether specific factors predict costs in the conversion of AF.

Methods: The study was conducted from the US hospital-payer perspective. Direct medical costs ($US, 2002 values) including drugs, intravenous admixture and administration, DCC, electrocardiographs and physicians’ fees were obtained directly from the provider. Nonparametric bootstrapping was conducted to calculate confidence intervals for the incremental cost-effectiveness ratios. One-way sensitivity analysis was conducted varying efficacy, and drug, hospital and physician costs. Multivariate analysis was conducted to determine whether specific baseline factors were predictors of total cost.

Results: Total costs per patient were lower in the ibutilide plus magnesium group compared with ibutilide alone ($US1075 vs $US1201); however, the difference was not statistically significant (p = 0.116). Patients receiving ibutilide plus magnesium had lower DCC costs compared with those receiving ibutilide alone ($US261 vs $US399; p = 0.036), but higher magnesium-associated costs ($US0.50 vs $US0; p < 0.001). Bootstrapping revealed that the ibutilide plus magnesium strategy would result in lower costs and greater efficacy 93.4% of the time. These results remained robust to changes in both cost and efficacy. No baseline factors were found to be independent predictors of total costs.

Conclusions: Our data suggest that adding prophylactic magnesium to ibutilide may be cost effective, from a US hospital-payer perspective, for the acute conversion of patients in AF or flutter compared with ibutilide alone.

Keywords

Atrial Fibrillation Ventricular Arrhythmia Ibutilide Intravenous Magnesium Hartford Hospital 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

This study was funded by the American College of Clinical Pharmacy/Merck Cardiovascular Fellowship award. The authors have no conflicts of interest to declare.

References

  1. 1.
    Stambler BS, Wood MA, Ellenbogen KA, et al. Efficacy and safety of repeated dose intravenous ibutilide for rapid conversion of atrial flutter or fibrillation. Circulation 1996; 94: 1613–21PubMedCrossRefGoogle Scholar
  2. 2.
    VanderLugt JT, Mattioni T, Denker S, et al. Efficacy and safety of ibutilide fumarate for the conversion of atrial arrhythmias after cardiac surgery. Circulation 1999; 100 (4): 369–75PubMedCrossRefGoogle Scholar
  3. 3.
    Dunn AB, White CM, Reddy P, et al. Fificacy and cost analysis of ibutilide. Ann Pharmacother 2000; 34: 1233–7PubMedCrossRefGoogle Scholar
  4. 4.
    Eversole A, Hancock W, Johns T, et al. Ibutilide: efficacy and safety in AF and atrial flutter in a general cardiology practice. Clin Cardiol 2001; 24 (7): 521–5Google Scholar
  5. 5.
    Zarkin GA, Bala MV, Calingaert B, et al. The cost-effectiveness of ibutilide versus direct current cardioversion in the conversion of AF and flutter to normal rhythm. Am J Manag Care 1997; 3: 1387–94PubMedGoogle Scholar
  6. 6.
    Murdock DK, Schumock GT, Kaliebe J, et al. Clinical and cost comparison of ibutilide and direct current cardioversion for AF and flutter. Am J Cardiol 2000; 85: 503–6PubMedCrossRefGoogle Scholar
  7. 7.
    Cropp JS, Antal EG, Talbert RL. Ibutilide: a new class III antiarrhythmic agent. Pharmacotherapy 1997; 17: 1–9PubMedGoogle Scholar
  8. 8.
    Tzivoni D, Banai S, Schuger C, et al. Treatment of torsade de pointes with magnesium sulfate. Circulation 1988; 77: 392–7PubMedCrossRefGoogle Scholar
  9. 9.
    White CM, Xie J, Chow MSS, et al. Prophylactic magnesium to decrease the arrhythmogenic potential of class III antiarrhythmic agents in a rabbit model. Pharmacotherapy 1999; 19: 635–40PubMedCrossRefGoogle Scholar
  10. 10.
    Kalus JS, Spencer AP, Tsikoris JP, et al. The impact of prophylactic magnesium on the efficacy of ibutilide for conversion of AF or flutter [abstract]. Circulation 2002; 106: 634Google Scholar
  11. 11.
    Thompson SG, Barber JA. How should cost data in pragmatic randomised trials be analyzed? BMJ 2000; 320: 1197–200PubMedCrossRefGoogle Scholar
  12. 12.
    Hunink MGH, Bult JR, De Vries J, et al. Uncertainty in decision models analyzing cost-effectiveness: the joint distribution of incremental costs and effectiveness evaluated with a nonpararretric bootstrap method. Med Decis Making 1998; 18: 337–46PubMedCrossRefGoogle Scholar
  13. 13.
    Gold MR, Siegel JE, Russell LB, et al., editors. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996: 176–213Google Scholar
  14. 14.
    Briggs A, Fenn P. Confidence intervals or surfaces?: uncertainty on the cost-effectiveness plane. Health Econ 1998; 7: 723–40PubMedCrossRefGoogle Scholar
  15. 15.
    Giri S, White CM, Dunn AB. Oral amiodarone for prevention of atrial fibrillation after open heart surgery, the Atrial Fibrillation Suppression trial (AFIST): a randomised placebo-controlled trial. Lancet 2001; 357: 830–6PubMedCrossRefGoogle Scholar
  16. 16.
    Kalus JS, White CM, Caron MF, et al. Indicators of atrial fibrillation risk in cardiac surgery patients on prophylactic amiodarone. Annals Thorac Surg 2004; 77: 1288–92CrossRefGoogle Scholar
  17. 17.
    Passman R, Beshai J, Pavri B, et al. Predicting past-coronary bypass surgery atrial arrhythmias from the preoperative electrocardiogram. Am Heart J 2001; 142: 806–10PubMedCrossRefGoogle Scholar
  18. 18.
    Burmaster DE, Andeson PD. Principles of good practice for the use of Monte Carlo techniques in human health and ecological risk assessments. Risk Anal 1994; 14: 477–81Google Scholar

Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  • Craig I. Coleman
    • 1
    • 2
  • James S. Kalus
    • 1
    • 2
  • C. Michael White
    • 1
    • 2
  • Anne P. Spencer
    • 3
  • James P. Tsikouris
    • 4
  • Jenny O. Chung
    • 2
  • Kenneth W. Kenyon
    • 1
  • Martin Ziska
    • 4
  • Jeffrey Kluger
    • 5
    • 6
  • Prabashni Reddy
    • 7
  1. 1.Department of Drug InformationHartford HospitalHartfordUSA
  2. 2.The University of ConnecticutCollege of PharmacyStorrs and FarmingtonUSA
  3. 3.Medical University of South CarolinaCollege of PharmacyCharlestonUSA
  4. 4.Texas Tech-University Medical CenterLubbockUSA
  5. 5.Department of CardiologyHartford HospitalHartfordUSA
  6. 6.The University of Connecticut, College of MedicineStorrs and FarmingtonUSA
  7. 7.ABT Associates Clinical TrialCambridgeUSA

Personalised recommendations