Cost-Effectiveness of Cardioversion and Antiarrhythmic Therapy in Nonvalvular Atrial Fibrillation

Catherwood, Edward; Fitzpatrick, W D; Greenberg, Mark; Holzberger, Peter T.; Malenka, David J.; Gerling, Barbara R.; Birkmeyer, John D.

doi:10.7326/0003-4819-130-8-199904200-00002

Cited by 60 publications

(31 citation statements)

References 71 publications

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“…We estimated the costs of these adverse events from previously published studies, [12][13][14] adjusted by the appropriate consumer price indices for medical care.…”

Section: Costs Of Major Adverse Eventsmentioning

confidence: 99%

Pharmacoeconomic analysis of oprelvekin (recombinant human interleukin‐11) for secondary prophylaxis of thrombocytopenia in solid tumor patients receiving chemotherapy

Cantor

Elting

Hudson

et al. 2003

Cancer

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BACKGROUNDPrevious research has shown oprelvekin (recombinant human interleukin‐11 [rhIL‐11]) to be effective in reducing the requirements for platelet transfusions after myelosuppressive chemotherapy in patients who have previously experienced thrombocytopenia. The economic consequences of the routine use of this platelet growth factor and the usual standard of platelet transfusions for prophylaxis of severe chemotherapy‐induced thrombocytopenia have not been compared.METHODSThe authors constructed a decision‐analytic model to compare the alternatives of rhIL‐11 versus usual care using probability, outcome, and cost data from previously published clinical trials and their own institutional sources. They incorporated the costs of platelet transfusions and adverse events from rhIL‐11 into the analysis. Quality‐of‐life outcomes were not considered. The pharmacoeconomic analysis was based on the criterion of cost minimization from the payer's perspective.RESULTSThe expected cost of the usual care strategy for prophylaxis of severe thrombocytopenia (transfusion when platelets < 20,000 μL−1) was $3495 for a 3‐week cycle of chemotherapy. The prophylactic rhIL‐11 strategy was more expensive, with an expected cost of $5328 over the same time period. Nonetheless, it was associated with fewer platelet transfusions, avoiding an average of 6.7 U compared with usual care. The savings from avoidance of platelet transfusion and adverse reactions to transfusion from the use of rhIL‐11 were not offset by the substantial cost of the pharmaceutical. The greater expected costs from the rhIL‐11 strategy were relatively insensitive to the unit price and efficacy of rhIL‐11 and the costs of platelet transfusions and monitoring.CONCLUSIONSFrom the payer's perspective, rhIL‐11 cannot be considered a cost‐saving clinical strategy compared with routine platelet transfusions for patients with severe chemotherapy‐induced thrombocytopenia. Cancer 2003;97:3099–106. © 2003 American Cancer Society.DOI 10.1002/cncr.11447

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“…We estimated the costs of these adverse events from previously published studies, [12][13][14] adjusted by the appropriate consumer price indices for medical care.…”

Section: Costs Of Major Adverse Eventsmentioning

confidence: 99%

Pharmacoeconomic analysis of oprelvekin (recombinant human interleukin‐11) for secondary prophylaxis of thrombocytopenia in solid tumor patients receiving chemotherapy

Cantor

Elting

Hudson

et al. 2003

Cancer

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“…16 In contrast, cardioversion alone followed by repeated cardioversion plus low-dose amiodarone on relapse was most cost-effective for patients at moderate to high risk for ischemic stroke.…”

Section: Prevention Of Embolism and Its Costmentioning

confidence: 96%

Cost-Effectiveness of Antiarrhythmic Drugs for Prevention of Thromboembolism in Patients With Paroxysmal Atrial Fibrillation.

Therapy¹

2001

Jpn Circ J

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To determine whether treatment with antiarrhythmic drugs could be cost-effective in preventing thromboembolic events in patients with paroxysmal atrial fibrillation (AF), 4 groups of patients without prior thromboembolism were studied. Group A: 193 patients with paroxysmal AF receiving antiarrhythmic drugs, but not antiplatelets or warfarin; Group B: 228 patients with paroxysmal AF not receiving antiarrhythmics, antiplatelets or warfarin; Group C: 284 patients with chronic AF receiving warfarin; Group D: 394 patients with chronic AF not receiving antiplatelets or warfarin. Direct costs for treatment of AF were determined. During a follow-up period of 4.6 years, the prevalence of thromboembolic episodes was lower by 70% in Group A and by 47% in Group C than in each control group. To prevent one thromboembolic event annually with antiarrhythmic drugs in patients with paroxysmal AF, an extra cost of 6.16 million yen was required. This less favorable cost-effectiveness was mainly because of physician's preference for new antiarrhythmic drugs. In contrast, treatment with warfarin required an extra cost of 1.09 million yen to prevent one thromboembolic event annually in patients with chronic AF. Antiarrhythmic drugs are less cost-effective in preventing thromboembolic events in patients with paroxysmal AF when new, expensive drugs are preferentially selected. (Jpn Circ J 2001; 65: 765 -768)

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“…5 © Urban & Vogel b) Zur Prävention der Folgen der Rhythmusstörung liegt eine Vielzahl von Einzelanalysen von unterschiedlichsten Aspekten der Therapie von Vorhofflimmern vor. Diese reichen von Kosten-NutzenAnalysen der Antikoagulation [60] über KostenEffektivitäts-Untersuchungen der Akuttherapie von neu aufgetretenem Vorhofflimmern [30] bis hin zu ökonomischen Modellen, die die Kardioversion mit der Frequenzkontrolle vergleichen [21]. Wir möchten drei wichtige Aspekte hierzu aufgreifen und unter ökonomischen Gesichtspunkten diskutieren: Rhythmuskontrolle versus Frequenzkontrolle, invasive versus medikamentöse Frequenzkontrolle, Kosten-NutzenVerhältnis der Antikoagulation und innovative invasive Therapien.…”

Section: Figureunclassified

“…Da diese fundamentale Frage derzeit noch nicht beantwortet werden kann, sind alle Kosten-Nutzen-Analysen der Therapie des Vorhofflimmerns letztlich mit einem Fragezeichen zu versehen. Eine Untersuchung von Catherwood et al [21] kommt auf der Basis eines hypothetischen Patientenkollektivs 70-jähriger Patienten und der vorhandenen Literatur zu dem Schluss, dass eine Rhythmuskontrolle effektiver und kostengünstiger ist als Frequenzkontrolle und Antikoagulation. Der Arm der Rhythmuskontrolle umfasste dabei mehrfache Kardioversionen und die Therapie mit Amiodaron und Chinidin.…”

Section: Figureunclassified

“…Dabei fußen diese und andere vergleichbare Analysen [21,32] auf so vielen Unbekannten, dass sie aus medizinischer Sicht letztlich -wegen der ungeklärten Grundsatzfrage -wertlos sind. Und obwohl Studien über die serielle Antiarrhythmikabehandlung und wiederholte Kardioversion bereits zeigen konnten, dass zum Beispiel die mit Vorhofflimmern assoziierte Herzinsuffizienz sich aufgrund hoher Rezidivraten nicht verhindern lässt [90], nehmen die zitierten Analysen doch einen hypothetischen positiven Effekt der Rhythmuskontrolle an [21,32]. Die einzigen vorläufigen Daten liegen derzeit aus der PIAF-(Pharmacological Intervention in Atrial Fibrillation-) Studie vor.…”

Section: Figureunclassified

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Sozioökonomische Aspekte der Behandlung von Herzrhythmusstörungen

Neuzner

Carlsson²

2000

Herz

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In the current clinical cardiac electrophysiology well-defined and effective concepts regarding the diagnostic and treatment of cardiac arrhythmias have been introduced. A further improvement in the cost-benefit and the cost-effectiveness relationships in several fields of cardiac electrophysiology depends on the future technical progress and on the results of ongoing and future scientific studies. On the other side very cost-saving electrophysiological treatments had been developed; the broader clinical use of these treatments is a possibility to optimize the costs for patients' care with cardiac arrhythmias.

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Cost-Effectiveness of Cardioversion and Antiarrhythmic Therapy in Nonvalvular Atrial Fibrillation

Abstract: Cardioversion alone should be the initial management strategy for persistent nonvalvular atrial fibrillation. On relapse of arrhythmia, repeated cardioversion plus low-dose amiodarone is cost-effective for patients at moderate to high risk for ischemic stroke.

Cited by 60 publications

References 71 publications

Pharmacoeconomic analysis of oprelvekin (recombinant human interleukin‐11) for secondary prophylaxis of thrombocytopenia in solid tumor patients receiving chemotherapy

Pharmacoeconomic analysis of oprelvekin (recombinant human interleukin‐11) for secondary prophylaxis of thrombocytopenia in solid tumor patients receiving chemotherapy

Cost-Effectiveness of Antiarrhythmic Drugs for Prevention of Thromboembolism in Patients With Paroxysmal Atrial Fibrillation.

Sozioökonomische Aspekte der Behandlung von Herzrhythmusstörungen

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