Cost evaluation of rhythm control methods for atrial fibrillation: evidence from CTAF.
Atrial fibrillation (AF) is a highly prevalent arrhythmia that is difficult to treat and generates important health care costs. One consideration in the selection of various therapeutic options is the cost of a given treatment compared to that of alternatives. The Canadian Trial of Atrial Fibrillation (CTAF) evaluated the effectiveness of sinus rhythm maintenance with amiodarone compared to propafenone or sotalol in a prospective, randomized fashion. A subsequent CTAF substudy of the medical costs associated with amiodarone vs. propafenone/sotalol found that amiodarone decreased AF-related costs. This paper reviews the results of the CTAF cost-analysis substudy in the context of other analyses in the literature of the cost effectiveness of amiodarone in AF. The costs associated with amiodarone therapy are no greater than for other sinus rhythm maintenance drugs, and for some cost categories and some patient subgroups are likely to be less, despite amiodarone's greater therapeutic efficacy. However, additional considerations are important in evaluating the clinical place of amiodarone, including its adverse effect and pharmacokinetic profile. As well, the results of recent randomized clinical trials have highlighted the limitations of sinus rhythm maintenance as a primary therapeutic objective in AF. The decision about whether and at what point to use amiodarone in a given patient requires a careful analysis of the individual case, in terms of symptomatology during AF, the response to previous treatment regimes, and risk factors for various forms of adverse drug reactions.
Nattel
Stanley
S
Department of Medicine and Research Center, Montreal Heart Institute and University of Montreal, Canada. nattel@icm.umontreal.ca
Lumer
Gerald
G
Talajic
Mario
M
Roy
Denis
D
D000638:Amiodarone / Q000191:economics / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D006801:Humans; D011405:Propafenone / Q000191:economics / Q000627:therapeutic use; D013015:Sotalol / Q000191:economics / Q000627:therapeutic use
D000889:Anti-Arrhythmia Agents; D011405:Propafenone; D013015:Sotalol; D000638:Amiodarone