Yonsei Med J.  2019 Dec;60(12):1157-1163. 10.3349/ymj.2019.60.12.1157.

Cost-Effectiveness of Rate- and Rhythm-Control Drugs for Treating Atrial Fibrillation in Korea

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. cby6908@yuhs.ac
  • 2Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea. preman@yuhs.ac
  • 3Institute of Human Complexity and Systems Science, Yonsei University, Seoul, Korea.

Abstract

PURPOSE
Although the economic and mortality burden of atrial fibrillation (AF) is substantial, it remains unclear which treatment strategies for rate and rhythm control are most cost-effective. Consequently, economic factors can play an adjunctive role in guiding treatment selection.
MATERIALS AND METHODS
We built a Markov chain Monte Carlo model using the Korean Health Insurance Review & Assessment Service database. Drugs for rate control and rhythm control in AF were analyzed. Cost-effective therapies were selected using a cost-effectiveness ratio, calculated by net cost and quality-adjusted life years (QALY).
RESULTS
In the National Health Insurance Service data, 268149 patients with prevalent AF (age ≥18 years) were identified between January 1, 2013 and December 31, 2015. Among them, 212459 and 55690 patients were taking drugs for rate and rhythm control, respectively. Atenolol cost $714/QALY. Among the rate-control medications, the cost of propranolol was lowest at $487/QALY, while that of carvedilol was highest at $1363/QALY. Among the rhythm-control medications, the cost of pilsicainide was lowest at $638/QALY, while that of amiodarone was highest at $986/QALY. Flecainide and propafenone cost $834 and $830/QALY, respectively. The cost-effectiveness threshold of all drugs was lower than $30000/QALY. Compared with atenolol, the rate-control drugs propranolol, betaxolol, bevantolol, bisoprolol, diltiazem, and verapamil, as well as the rhythm-control drugs sotalol, pilsicainide, flecainide, propafenone, and dronedarone, showed better incremental cost-effectiveness ratios.
CONCLUSION
Propranolol and pilsicainide appear to be cost-effective in patients with AF in Korea assuming that drug usage or compliance is the same.

Keyword

Atrial fibrillation; drugs; cost effectiveness; QALY

MeSH Terms

Amiodarone
Atenolol
Atrial Fibrillation*
Betaxolol
Bisoprolol
Compliance
Cost-Benefit Analysis
Diltiazem
Flecainide
Humans
Insurance, Health
Korea*
Markov Chains
Mortality
National Health Programs
Propafenone
Propranolol
Quality-Adjusted Life Years
Sotalol
Verapamil
Amiodarone
Atenolol
Betaxolol
Bisoprolol
Diltiazem
Flecainide
Propafenone
Propranolol
Sotalol
Verapamil

Figure

  • Fig. 1 Decision tree model. The treatment strategies are shown on the left in patients with newly diagnosed atrial fibrillation between January 1, 2013 and December 31, 2015 in Korea. Markov node (M) indicates a Markov process with eight health statuses and a cycle length of 1 year until death occurred or the 20-year time horizon was reached. Probabilities of health events depend on the treatment. Patients could die of ischemic stroke, intracranial hemorrhage, myocardial infarction, gastrointestinal bleeding, or other comorbidities. AF, atrial fibrillation.

  • Fig. 2 Cost-effectiveness (bars) of rate-control drugs in patients with newly diagnosed atrial fibrillation between January 1, 2013 and December 31, 2015 in Korea. All drugs remained cost-effective at a willingness-to-pay threshold of $30000 per quality-adjusted life year (QALY).

  • Fig. 3 Cost-effectiveness (bars) of rhythm-control drugs in patients with newly diagnosed atrial fibrillation between January 1, 2013 and December 31, 2015 in Korea. All drugs remained cost-effective at a willingness-to-pay threshold of $30000 per quality-adjusted life years (QALY).


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