OBJECTIVES

To evaluate the long-term cost-effectiveness of dronedarone compared with amiodarone for the treatment of Atrial Fibrillation (AF) from the perspective of health care system in China.

METHODS

A 9-state Markov model with 3-month cycle was developed based on the published studies and was approved by experts. The lifetime cost-effectiveness will be estimated and incidence of relevant clinical events, such as AF recurrence, stroke, myocardial infraction (MI) and heart failure (HF) will be simulated. The probabilities of experiencing AF recurrence, stroke, MI and HF were obtained from existent retrospective database analysis and meta-analysis. Mortality rate from life table in China was adjusted with the risk ratio or hazard ratio from literature. Costs were collected from Chinese Health Statistics 2020, published documents and bidding prices from website. All the costs were inflated to 2020 using the consumer price index of healthcare component. The utility values were obtained from literature. A 5% discount rate was applied to both costs and health outcomes. One-way and probability sensitivity analysis was performed.

RESULTS

Dronedarone was associated with improved life years of 0.30 (3.77 vs. 3.47) and quality-adjusted life years (QALYs) of 0.13 (2.37 vs. 2.25) compared with amiodarone. Improvements were mostly driven by the benefits from avoided complications and adverse events. The simulated lifetime cost of dronedarone was higher than that of amiodarone with CNY 21,396 (CNY 30,582 vs. CNY 9,185) which was mostly results from the higher drug cost (CNY 3,285 vs. CNY 286 per cycle). The incremental cost-effectiveness ratio (ICER) of dronedarone compared with amiodarone was CNY 169,166/QALY. One-way sensitivity analysis confirmed the robustness of the results. Compared with amiodarone, dronedarone had 69% probability to be the cost-effective option under the commonly used willingness-to-pay (CNY 212,676/QALY) in China.

CONCLUSIONS

Dronedarone is estimated to be a cost-effective treatment option compared with amiodarone for AF patient in China.