title: Cost analysis of transthoracic cardioversion of atrial fibrillation with and without ibutilide pretreatment.
abstract: BACKGROUND
  Ibutilide may result in chemical cardioversion of atrial fibrillation and facilitates transthoracic cardioversion by lowering the defibrillation energy requirement. Whether routine pretreatment with ibutilide increases or decreases the cost of cardioversion is unknown. The purpose of this study was to compare the cost of outpatient transthoracic cardioversion of atrial fibrillation with and without ibutilide pretreatment.
  
  
  METHODS
  Using a model based on published literature and hospital accounting information, a hypothetical group of 100 patients with atrial fibrillation and a left ventricular ejection fraction >0.30 underwent 2 strategies of outpatient cardioversion: transthoracic cardioversion with and without routine pretreatment with 1 mg ibutilide, and with and without involvement of an anesthesiologist for sedation. If transthoracic cardioversion was unsuccessful in patients who did not receive ibutilide, transthoracic cardioversion was repeated after administration of ibutilide.
  
  
  RESULTS
  If an anesthesiologist was involved, transthoracic cardioversion with ibutilide was associated with incremental cost-savings as the efficacy of ibutilide alone in restoring sinus rhythm increased above the critical values of 20%, 27%, and 35% when the efficacy of transthoracic cardioversion alone was 60%, 80%, and 100%, respectively. In the absence of an anesthesiologist, routine pretreatment with ibutilide increased the cost of cardioversion at all success rates of transthoracic cardioversion.
  
  
  CONCLUSIONS
  In the presence of an anesthesiologist, whether or not routine pretreatment with ibutilide lowers the mean cost of cardioversion is determined by the success rates of chemical cardioversion with ibutilide and transthoracic cardioversion. In the absence of an anesthesiologist, ibutilide pretreatment increases the cost of cardioversion.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI 48109-0022, USA.
authors.forename: H
authors.initials: H
authors.lastname: Oral
authors.forename: B P
authors.initials: BP
authors.lastname: Knight
authors.forename: C
authors.initials: C
authors.lastname: Sticherling
authors.forename: M H
authors.initials: MH
authors.lastname: Kim
authors.forename: R L
authors.initials: RL
authors.lastname: Baker
authors.forename: S P
authors.initials: SP
authors.lastname: Chough
authors.forename: K
authors.initials: K
authors.lastname: Wasmer
authors.forename: F
authors.initials: F
authors.lastname: Pelosi
authors.forename: G F
authors.initials: GF
authors.lastname: Michaud
authors.forename: A M
authors.initials: AM
authors.lastname: Fendrick
authors.forename: S A
authors.initials: SA
authors.lastname: Strickberger
authors.forename: F
authors.initials: F
authors.lastname: Morady
mesh_terms: D000768:Anesthesia, General / Q000191:economics; D000889:Anti-Arrhythmia Agents / Q000191:economics* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000628:therapy*; D017046:Cost Savings; D004554:Electric Countershock / Q000191:economics* / Q000379:methods; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D010045:Outpatients; D013449:Sulfonamides / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D000889:Anti-Arrhythmia Agents; D013449:Sulfonamides; C067192:ibutilide