title: Economic analysis of intravenous plus oral amiodarone, atrial septal pacing, and both strategies to prevent atrial fibrillation after open heart surgery.
abstract: OBJECTIVE
  To compare the cost-effectiveness of intravenous plus oral amiodarone, atrial septal pacing, and both strategies combined to prevent atrial fibrillation after open heart surgery. Secondary objectives were to compare the cost-effectiveness of amiodarone versus no amiodarone and of pacing versus no pacing, and to compare hospitalization costs of the various strategies.
  
  
  METHODS
  Piggyback cost analysis of a randomized, 2 x 2 factorial trial.
  
  
  METHODS
  Urban academic hospital.
  
  
  METHODS
  One hundred and sixty patients with coronary artery and/or valvular disease.
  
  
  METHODS
  Patients were randomized to receive amiodarone or matching placebo and then further randomized to receive atrial septal pacing or no pacing.
  
  
  RESULTS
  The economic analysis was conducted from a hospital perspective. Charges were converted to costs using cost:charge ratios. For the cost-effectiveness analysis, a joint distribution of costs and effectiveness was performed using the nonparametric bootstrap method. Amiodarone plus pacing significantly decreased the frequency of atrial fibrillation after open heart surgery, compared with amiodarone alone, pacing alone, and placebo. Total costs (mean+/-SD) were $27,026+/-30,226 for the placebo group, $22,725+/-17,661 for the amiodarone group, $33,868+/-60,309 for the pacing group, and $18,697+/-8174 for the amiodarone plus pacing group (p=0.27). In the joint distribution cost-effectiveness analysis, when compared with placebo, the probability of lower cost but higher effect (superiority) was 67% for amiodarone, 15% for pacing, and 97% for amiodarone plus pacing. In the multivariate analysis, preoperative beta-blockers and amiodarone were negatively associated with hospital costs (p<0.05).
  
  
  CONCLUSIONS
  Data suggest that both amiodarone alone and the combination of amiodarone plus pacing are cost-effective compared with placebo. Additional comparative studies of these strategies are warranted to confirm these findings.
authors.affiliation: School of Pharmacy, University of Connecticut, Storrs, USA.
authors.forename: Prabashni
authors.initials: P
authors.lastname: Reddy
authors.forename: James S
authors.initials: JS
authors.lastname: Kalus
authors.forename: Michael F
authors.initials: MF
authors.lastname: Caron
authors.forename: Sheryl
authors.initials: S
authors.lastname: Horowitz
authors.forename: Angiliki
authors.initials: A
authors.lastname: Karapanos
authors.forename: Craig I
authors.initials: CI
authors.lastname: Coleman
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kluger
authors.forename: C Michael
authors.initials: CM
authors.lastname: White
mesh_terms: D000284:Administration, Oral; D000638:Amiodarone / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000191:economics; D006348:Cardiac Surgical Procedures; D003362:Cost-Benefit Analysis; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone