Abstract
Abstract only
Introduction:
In the ATHENA trial, dronedarone reduced the rate of first cardiovascular (CV) hospitalization by 26% in patients with paroxysmal or persistent atrial fibrillation/flutter (AF/AFL). This analysis quantifies the impact of dronedarone on hospitalization events and healthcare costs among AF/AFL patients in real-world practice.
Methods:
This retrospective cohort study identified patients aged ≥18 years with ≥2 concurrent
de novo
pharmacy claims for dronedarone (≥180 days’ total supply) from the MarketScan database (June 2009[[Unable to Display Character: ‒]]March 2011). Patients had to have an AF/AFL diagnosis (ICD-9-CM codes 427.31/427.32) and no heart failure-related hospitalization during the 12-month period before the initial (index) dronedarone claim, and continuous pre-index (≥12 months) and post-index (≥6 months) insurance coverage. Patients were followed until (the earlier of) end of dronedarone supply or health insurance disenrollment. Annualized hospital and emergency room (ER) admissions/visits (all-cause, CV- and AF-related) and healthcare costs were compared between baseline and follow-up.
Results:
In total, 5,656 patients (mean age 68.3 years; 62% male; mean Charlson Comorbidity Index 1.50) were treated with dronedarone and were followed for (mean ± SD) 11.9 ± 4.7 months. Mean numbers of annualized all-cause, CV-related, and AF-related hospitalizations and ER visits were reduced (
P
<0.0001) after dronedarone initiation (Table). All-cause hospital and ER costs declined (28% and 26%, respectively) after dronedarone initiation; this was offset by increases in total outpatient and prescription costs (14% and 79%, respectively) (Table). Overall, total (inpatient, outpatient, and prescription) costs increased marginally (8%) after dronedarone initiation (mean $25,650
vs
$23,815 per patient-year,
P
<0.01). Patients switching to dronedarone from other antiarrhythmic drugs (n=2,080) showed similar reductions in hospital and ER events and costs; for this cohort, total healthcare costs were minimally affected by dronedarone initiation [mean $26,248 (baseline)
vs
$26,928 (follow-up) per patient-year,
P
=0.51].
Conclusions:
Dronedarone use in real-world practice results in substantial reductions in hospital admissions and variable overall costs in first- and second-line treatment of AF/AFL.