Clinical and Economic Outcomes Associated With Use of Anti-Arrhythmic Drugs Versus Ablation in Atrial Fibrillation (AFib)
Author(s)
Ken-Opurum J1, Vadagam P1, Faith L1, Srinivas SSS2, Preblick R3, Park S3, Charland S4, Revel A3
1Axtria, Berkeley Heights, NJ, USA, 2Axtria Inc, Berkley Heights, NJ, USA, 3Sanofi, Bridgewater, NJ, USA, 4SanofiUS, Golden, CO, USA
Presentation Documents
OBJECTIVES: AFib, an arrhythmia with increased risk for stroke, heart failure, and other cardiovascular complications, is treated with anticoagulation, rate control medications, antiarrhythmic drugs (AADs), cardioversion, and/or ablation. This study evaluates the clinical and economic benefits of rhythm control with AADs or ablation.
METHODS: An economic model was developed for: 1) direct comparison between individual AADs (dronedarone, amiodarone, sotalol, flecanide, propafenone, and dofetilide) vs. ablation; 2) combination therapy of AADs(class)+ablation; 3) sequential use of AADs(class)
àablation vs. ablationàAADs(class). Inputs include adverse event rates (AEs; withdrawal due to AE, proarrhythmia, stroke, and AFib recurrence) and costs (AEs, procedural, drug [with discounts], administration, and copay/coinsurance). Rates for AEs in direct comparisons are calculated utilizing risk ratios obtained from a Cochrane safety review and untreated risks obtained from real-world data (RWD) analysis. Rates of AEs for other analyses are obtained from RWD. AE costs are calculated from AE rate and cost for a single event. Literature costs (2021) are adjusted for inflation. Results are summarized as plan costs per patient per year (PPPY). One-way sensitivity analysis (OWSA) evaluated the impact of individual parameters.RESULTS: In direct comparisons, medication/procedural costs were highest for ablation ($29,432), followed by dofetilide ($7,659), dronedarone ($6,447), sotalol ($4,552), propafenone ($3,044), flecanide ($2,563), and amiodarone ($2,538). AE costs were highest for flecanide ($22,964), followed by dofetilide ($17,462), sotalol ($15,030), amiodarone ($12,450), dronedarone ($10,424), propafenone ($7,678), and ablation ($5,944). AADs(class)+ablation resulted in cost savings vs. ablation alone ($12,818 vs. $35,376), while AADs(class)
àablation was cost saving compared to ablationàAADs(class) ($12,061 vs. $14,962). In OWSA of direct comparisons, key drivers of PPPY included costs of ablation, percentage of patients undergoing re-ablation, and withdrawal due to AEs.CONCLUSIONS: Ablation is the most costly treatment option, despite lower AE costs. Combination therapy and AADs administered ahead of ablation also result in lower PPPY costs.
Conference/Value in Health Info
Value in Health, Volume 25, Issue 12S (December 2022)
Code
EE230
Topic
Economic Evaluation
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)