title: Analysis of the cost-effectiveness of dronedarone versus amiodarone, propafenone, and sotalol in patients with atrial fibrillation: results for Serbia.
abstract: BACKGROUND
  Recent studies have shown that dronedarone is associated with significantly fewer adverse effects and treatment discontinuations, and a trend toward reduced all-cause mortality, compared with amiodarone. Introduction of dronedarone in clinical practice is limited by its higher cost than amiodarone, propafenone, and sotalol.
  
  
  OBJECTIVE
  To estimate cost-effectiveness of dronedarone versus amiodarone, propafenone, and sotalol in patients with atrial fibrillation (AF).
  
  
  METHODS
  We constructed a Markov model, which was then simulated by Monte Carlo simulation using 1,000 virtual patients. Costs and outcomes were estimated from the societal perspective and discounted at 3% annually. A lifetime horizon and three-month cycle length were used. The main outcome measurement was the number of years spent without stroke. Values of transition probabilities and therapy outcomes were estimated from available literature. The prices of health services and drugs were obtained from the Republic Institute for Health Insurance Tariff Book and Drug List A and from the drug developer.
  
  
  RESULTS
  Cost-effectiveness shows that the dronedarone treatment option has the most advantageous relationship, where, for one year without a stroke, the total cost is €1,779.23. In the case of the amiodarone therapy option, for one year without a stroke €3,845.10 is needed, for propafenone €4,674.20, while for sotalol the sum is €14,973.89. Estimated annual costs for patients with first-detected AF in Serbia were €610.
  
  
  CONCLUSIONS
  The results of our model indicate that dronedarone is a cost-effective therapy compared with amiodarone, propafenone, and sotalol in patients with AF, if the outcome measurement is the number of years spent without stroke.
authors.affiliation: Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia. dankatesic@hotmail.com.
authors.forename: Danka
authors.initials: D
authors.lastname: Tesic
authors.forename: Marina
authors.initials: M
authors.lastname: Kostic
authors.forename: Dusko
authors.initials: D
authors.lastname: Paunovic
authors.forename: Slobodan M
authors.initials: SM
authors.lastname: Jankovic
mesh_terms: D000638:Amiodarone / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000191:economics* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D006801:Humans; D008962:Models, Theoretical; D011405:Propafenone / Q000191:economics* / Q000627:therapeutic use; D055771:Serbia; D013015:Sotalol / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000889:Anti-Arrhythmia Agents; D011405:Propafenone; D013015:Sotalol; D000638:Amiodarone