OBJECTIVES: Postoperative atrial-fibrillation (POAF) is common among surgical patients and associated with a worse outcome. Arterial-fibrillation (AF) is the most frequent complication arising after coronary-artery-bypass-grafting (CABG) surgery, occurring in 30% of cases. The incidence of this complication is even higher after valve-replacement surgery (30–40%) and after compound operative procedures (40–60%). Beta-blockers reduce POAF and supraventricular tachycardia and have direct antiarrhythmic activity. Landiolol hydrochloride, is an ultra-short-acting beta-blocker half-life of approximately 4 min. The selectivity ratio of landiolol is higher than other beta-blockers.

METHODS: A decision-model was developed to reflect the cost-effectiveness of landiolol vs. no-prevention, standard-of-care (SoC) and esmolol for the patient group with different cardiac surgeries and a subgroup of CABG. The model benefit is expressed in a reduction in POAF episodes and reduced complications. Clinical data were derived mainly from the meta-analysis of Li et al. (2015) involving 807 patients (9 RCTs). The model calculates total inpatient costs (incl. surgery, ICU, complication and re-hospitalisation) over the hospital-length-of-stay (LOS). Costs from published sources were used (2016 Euro) from the German hospital perspective. A one-way deterministic sensitivity-analysis accounts for uncertainty.

RESULTS:

Patients with POAF had a higher incidence of mortality, morbidity and LOS including ICU and more frequent readmissions and finally higher costs.Per patient costs with landiolol are estimated between 24,234.21€-25,910.02€ and AF occurred in 12.4%-19.1% of cases. Against no-prevention landiolol is able to reduce hospital cost by 1,636.10€ and decreases POAF by 24.9%. Compared with SoC landiolol lower hospital costs by 1,840.63€ and reduce POAF events by 20.1%. Analysing the CABG subgroup, per patient costs with landiolol are estimated between 23,960.86€-24,216.84€. AF cases occurred in 8.8%-12.1% of patients. Compared to comparators landiolol is able to reduce costs between 1,536.92€ (no-prevention) and 1,448.23€ (esmolol).

CONCLUSIONS:

The economic-analysis shows that the use of landiolol is highly cost-effective and associated with cost-savings.