OBJECTIVES : Sepsis and septic-shock are associated with cardiovascular problems, including tachyarrhythmia, myocardial injury, and changes in vasuclar endothelial function that might affect cardiac output with potential fatal outcome. The consequences of sepsis extend well beyond the acute illness. Tachycardia and new-onset atrial-fibrillation, often treated with less effective agents such as amiodarone, are key prognostic factors for sepsis and associated with increased use of health-care resources and costs. Early decrease of heart-rate is associated with improved outcome. The use of β-blockers for managing acute arrhythmias in patients with septic-shock has been described in the literature. Landiolol, an ultra-short-acting β1-selective adrenergic-receptor-antagonist, is used specifically for the acute management of atrial-fibrillation and atrial-flutter in critically-ill patients with/without cardiac-dysfunction.

METHODS : A decision-model was developed to reflect the cost-effectiveness of landiolol in addition to conventional-therapy vs. standard-of-care (SoC) to manage sepsis-related tachyarrhythmia. The model benefit was expressed in a reduction proportion of patients with new-onset arrhythmia and mortality. Clinical data were derived from a clinical-trial of Kakihana et al. (2020) involving 151 patients. The model calculates total inpatient costs (incl. hospital-stay, ICU and ventilation) over the hospital-length-of-stay (LOS). Costs from published sources were used (2020€) from the German hospital perspective. A one-way deterministic-sensitivity-analysis accounts for uncertainty.

RESULTS : Patients with sepsis-related tachyarrhythmia had a higher incidence of mortality, morbidity and LOS including ICU, a more frequent ventilation requirement and finally higher costs; new-onset arrhythmia occurred in 9.3% of cases and 12% of patients die within 28 days. Despite additional per patient costs of landiolol, landiolol is able to reduce hospital costs of 38,550€ (95%-CI=34,216–43,374; p-value=0.004) against SoC by -1,375.65€ and decreases new-onset arrhythmia by 64% [HR:0.357 (95%-CI=0.150–0.849; p-value=0.015]. Mortality declined by 40% when using landiolol [HR:0.599 (95%-CI=0.262–1.370; p-value=0.22]. Landiolol dominates SoC.

CONCLUSIONS : The economic-analysis shows that the use of landiolol is associated with costs saving from the payer’s perspective.