OBJECTIVES: Atrial fibrillation (Afib) is the most common arrhythmia. If untreated, it can lead to severe complications, including heart failure, stroke and death. Some common anti-arrhythmia medications, including sotalol, require in-hospital monitoring during drug initiation. IV sotalol has become commercially available in the US and may shorten drug initiation, potentially reducing resource utilization. A quantitative analysis comparing costs for a 3-day and 1-day initiation of oral and IV sotalol, respectively, was performed.

METHODS: A budget impact model (BIM) was created to estimate changing hospital costs, savings and revenue. The target patient population was defined as those who had either a primary or secondary Afib diagnosis and received a 3-day, in-patient initiation of oral sotalol. Data from Cerner Health Facts, a large US electronic health records database, and additional published sources were leveraged to identify the cost of administering medication, patient monitoring, room and board as well as total average CMS payments ($9,200) to the hospital. Hospital savings and revenue were estimated per-patient and based on hospital bed size of 300-500 beds.

RESULTS: The overall cost of initiating drug therapy, per-patient, on oral sotalol was estimated at $7,000 compared to $4,100 for IV sotalol. Cost of drug acquisition and dispensing of oral sotalol was relatively low ($650) compared to IV sotalol ($1,700), however, the increased hospital length of stay contributed to the overall cost of oral therapy ($5,600 for oral sotalol vs $1,800 for IV sotalol). The hospital revenue per patient on oral and IV sotalol was $2,200 and $5,100 respectively. Furthermore, we estimated that a 300-500 bed hospital could save up to $60,000/year by converting only 10% of its patients to IV sotalol.

CONCLUSIONS: Our BIM suggests that initiation with IV sotalol has the potential to lower overall hospital costs and increase hospital savings compared to oral sotalol.