Cost-Effectiveness of Antiarrhythmic Drugs for Treating Paroxysmal or Persistent Atrial Fibrillation in China
Author(s)
Fuming Li, PhD student, Dunming Xiao, PhD student, Yu Xia, PhD, Junling Weng, PhD student, Shimeng Liu, PhD, Yingyao Chen, PhD;
School of Public Health, Fudan University/ National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
School of Public Health, Fudan University/ National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
Presentation Documents
OBJECTIVES: Antiarrhythmic drug (AAD) therapies are foundational in the long-term management of atrial fibrillation (AF), yet there remains uncertainty in clinical and reimbursement decisions in China. This study aimed to estimate the cost-effectiveness of dronedarone compare to amiodarone and sotalol for the treatment of paroxysmal or persistent AF in China from the health system perspective.
METHODS: A Markov decision model was developed to compare the lifetime clinical efficacy and costs of three AAD therapies associated with AF recurrence, congestive heart failure, strokes, and deaths due to AF or AF related complications. Model inputs were derived from the ATHENA trial results, real-world database, published literature, and supplemented from expert opinion. Cost-effectiveness was measured by the incremental cost-effectiveness ratio (ICER) defined as the incremental cost per quality-adjusted life year (QALY) gained among groups.
RESULTS: This study used a simulated cohort with baseline characteristics of patients from the CCC-AF project. In the base case, compared to amiodarone and sotalol, dronedarone was expected to gain additional 1.28 QALYs (5.15 vs. 3.87) and 1.78 QALYs (5.15 vs. 3.37), with higher costs of $6,632 ($11,025 vs. $4,393) and $6,278 ($11,025 vs. $4,748) over a lifetime horizon, leading to ICERs of $5,166 and $3,524 per QALY, respectively. One-way sensitivity analysis revealed that the results were most sensitive to the relative risk of cardiovascular mortality. The probabilistic sensitivity analyses indicated that the probability of cost-effectiveness for dronedarone ranged from 97.0% to 99.4% at the threshold of one to three times China's per capita gross domestic product in 2023, whereas the probability for amiodarone ranged from 3.0% to <1%, and for sotalol was always <1%.
CONCLUSIONS: Our analysis suggests that dronedarone is a cost-effective AAD compared to amiodarone and sotalol for patients with paroxysmal or persistent AF in China, offering improvements in life expectancy and QALY in the long-term rhythm control.
METHODS: A Markov decision model was developed to compare the lifetime clinical efficacy and costs of three AAD therapies associated with AF recurrence, congestive heart failure, strokes, and deaths due to AF or AF related complications. Model inputs were derived from the ATHENA trial results, real-world database, published literature, and supplemented from expert opinion. Cost-effectiveness was measured by the incremental cost-effectiveness ratio (ICER) defined as the incremental cost per quality-adjusted life year (QALY) gained among groups.
RESULTS: This study used a simulated cohort with baseline characteristics of patients from the CCC-AF project. In the base case, compared to amiodarone and sotalol, dronedarone was expected to gain additional 1.28 QALYs (5.15 vs. 3.87) and 1.78 QALYs (5.15 vs. 3.37), with higher costs of $6,632 ($11,025 vs. $4,393) and $6,278 ($11,025 vs. $4,748) over a lifetime horizon, leading to ICERs of $5,166 and $3,524 per QALY, respectively. One-way sensitivity analysis revealed that the results were most sensitive to the relative risk of cardiovascular mortality. The probabilistic sensitivity analyses indicated that the probability of cost-effectiveness for dronedarone ranged from 97.0% to 99.4% at the threshold of one to three times China's per capita gross domestic product in 2023, whereas the probability for amiodarone ranged from 3.0% to <1%, and for sotalol was always <1%.
CONCLUSIONS: Our analysis suggests that dronedarone is a cost-effective AAD compared to amiodarone and sotalol for patients with paroxysmal or persistent AF in China, offering improvements in life expectancy and QALY in the long-term rhythm control.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE34
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), STA: Biologics & Biosimilars