Large cost burden associated with hospital antiarrythmic drug initiation

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ORLANDO, Fla.—In-hospital initiation of the antiarrhythmic therapies sotalol and dofetilide for atrial fibrillation (AF) represent an economic burden in the U.S., costing $3,389 per patient for the hospital stay during which therapy is initiated, according to a poster study presented Monday at the 58th annual American College of Cardiology (ACC) scientific sessions.

Even though antiarrhythmic drugs have been shown to be effective and improve quality of life for AF and atrial flutter, the risk of proarrythmia with some rhythm-control therapies to initiate treatment requires an inpatient hospital stay with telemetry or other electrocardiogram (ECG) monitoring. Therefore, the investigators examined the costs associated with initiating sotalol Betapace from Berlex Laboratories or Sotalex and Sotacor from Bristol-Myers Squibb) or dofetilide (Tikosyn from Pfizer) in the U.S. inpatient setting.

Michael H. Kim, MD, from Northwestern University Feinberg School of Medicine in Chicago, and colleagues conducted a retrospective cohort study using data from inpatient billing/discharge records in the Premier Perspective Database between Jan. 1, 2002 and Sept. 30, 2007. They included patients, who received at least four sotalol doses or at least five dofetilide doses starting within two days of admission (with at least one dose within three days of discharge.

Of the 7,290 patients (59 percent men, mean age 66 years), the authors reported that 4,847 received sotalol and 2,443 received dofetilide. Ninety-two percent were admitted to urban hospitals, 53 percent to teaching hospitals; and the median stay was three days. For 89 percent of the patients, the attending physician was a cardiologist. Overall, 34 percent underwent cardioversion and 12 percent transesophageal echo.

In 2007, the mean total inpatient costs per patient were $3,278 in the sotalol group and $3,610 in the dofetilide group, according to the authors. The greatest costs were for room/board ($1,874 for sotalol, $1,985 dofetilide) and cardiology/electrocardiograms ($394 sotalol, $443 dofetilide). Pharmacy costs were $230 and $201 per patient in the sotalol and dofetilide groups, respectively.

Kim and colleagues noted that the highest proportion of overall costs was accounted for by room/board, followed by cardiology/ECGs. They also said that the pattern of expenditure was similar for both sotalol and dofetilide.

"The development of novel therapies that can be initiated effectively in an outpatient setting may reduce resource utilization and thus be more cost-effective, as well as potentially improve patients' quality of life," the authors concluded.