title: Comparative cost-effectiveness analysis of quinidine, procainamide and mexiletine.
abstract: Quinidine and procainamide have the potential for major organ toxicity, whereas mexiletine has been reported to have little risk of organ toxicity, serious proarrhythmia or congestive heart failure, but a relatively high incidence of nuisance side effects. In light of the potential adverse effects of all antiarrhythmic agents as highlighted by the Cardiac Arrhythmia Suppression Trial, the relative cost-effectiveness of these 3 agents was assessed. Based on a review of greater than 1,000 published reports, studies included in the analysis examined greater than or equal to 1 of these agents in adults, with adequate efficacy or safety data, or both. The majority of studies assessed patients with symptomatic or malignant arrhythmias, or both. Data were analyzed using a decision analysis/cost-effectiveness model. Probabilities were averaged using techniques of meta-analysis. Costs were obtained from a university medical center cost-accounting system and from expected follow-up visits to university clinics. Thirty-seven separate side effects were included in the analysis. In terms of overall cost, 12 months of mexiletine would engender $875, quinidine $1,239 and procainamide $1,911 of expenses. Mexiletine dominates the older agents in terms of cost per successful drug response, a result that holds over a wide range of efficacy and safety data. Analyses demonstrated no increase in all-cause mortality for quinidine and mexiletine over placebo, but a trend toward higher mortality with procainamide. The results suggest that mexiletine is a cost-saving alternative therapy for ventricular arrhythmias when adverse reactions are considered in addition to pharmaceutical costs and treatment efficacy.
authors.affiliation: Cardiac Arrhythmia Service, University Hospital, Boston, Massachusetts 02118.
authors.forename: P J
authors.initials: PJ
authors.lastname: Podrid
authors.forename: P R
authors.initials: PR
authors.lastname: Kowey
authors.forename: W H
authors.initials: WH
authors.lastname: Frishman
authors.forename: R J
authors.initials: RJ
authors.lastname: Arnold
authors.forename: D J
authors.initials: DJ
authors.lastname: Kaniecki
authors.forename: J R
authors.initials: JR
authors.lastname: Beck
authors.forename: J R
authors.initials: JR
authors.lastname: Beshansky
mesh_terms: D000553:Ambulatory Care / Q000191:economics; D001145:Arrhythmias, Cardiac / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003658:Decision Making, Computer-Assisted; D003661:Decision Support Techniques; D003663:Decision Trees; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015201:Meta-Analysis as Topic; D008801:Mexiletine / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000150:complications; D011336:Probability; D011342:Procainamide / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D011802:Quinidine / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D008801:Mexiletine; D011802:Quinidine; D011342:Procainamide