Cost of hospital admission for antiarrhythmic drug initiation in atrial fibrillation.
BACKGROUND
Initiation of some rhythm-control therapies for atrial fibrillation (AF) requires an inpatient hospital stay and telemetry monitoring, adding to the cost burden of AF. However, specific cost data for inpatient initiation of AF therapies are lacking.


OBJECTIVE
To examine costs associated with initiating sotalol or dofetilide in the inpatient setting in the US.


METHODS
This retrospective cohort study used data from billing/discharge records in the Premier Perspective Database for adults with a primary diagnosis of AF, hospitalized between January 2002 and September 2007. Patients had to have received 4 or more sotalol doses or 5 or more dofetilide doses starting within 2 days of admission (with >/=1 dose within 3 days of discharge). Patients admitted solely for AF drug initiation were identified by excluding patients who were admitted on an emergency basis, received care in the emergency department, or underwent major surgical procedures. The primary outcome was direct medical costs for in-hospital services during the stay.


RESULTS
Among 7290 patients included in the analysis (4847 sotalol, 2443 dofetilide), mean total inpatient costs per patient were $3278 in the sotalol group and $3610 in the dofetilide group. The greatest costs were for room/board ($1874 sotalol, $1985 dofetilide) and cardiology/electrocardiograms ($394 sotalol, $443 dofetilide). Pharmacy costs were $230 and $201 per patient in the sotalol and dofetilide groups, respectively.


CONCLUSIONS
The admission of patients for in-hospital initiation of AF rhythm-control therapy represents a high cost burden in the US.
Kim
Michael H
MH
Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. michael.kim@nmff.org
Klingman
David
D
Lin
Jay
J
Pathak
Prathamesh
P
Battleman
David S
DS
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000191:economics*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010627:Phenethylamines / Q000008:administration & dosage / Q000191:economics; D012189:Retrospective Studies; D013015:Sotalol / Q000008:administration & dosage / Q000191:economics; D013449:Sulfonamides / Q000008:administration & dosage / Q000191:economics
D000889:Anti-Arrhythmia Agents; D010627:Phenethylamines; D013449:Sulfonamides; D013015:Sotalol; C063533:dofetilide