Purpose: This analysis assessed reduction of cardiovascular (CV) hospitalizations in the first 12 months of the ATHENA trial and the associated cost savings in the US.
Method: The ATHENA trial randomized atrial fibrillation/flutter (AF/AFL) patients (mean age 71.6 years) with ≥1 other CV risk factor to dronedarone (n=2,301) or placebo (n=2,327), plus standard care. In this cost analysis, hospitalization costs, derived from claims data for a US cohort of ‘ATHENA-like’ AF/AFL patients with Medicare supplemental insurance (n=10,200), were applied to hospitalization events occurring during the first 12 months of the ATHENA trial. Cost inputs (2008 values) were (i) weighted mean CV hospitalization costs, categorised according to admission cause, and (ii) Diagnosis Related Groups costs of hospitalizations for adverse events (AEs) in ATHENA. Cost variations were assessed using Monte Carlo sensitivity analysis.
Result: During the first 12 months of ATHENA, overall CV hospitalizations fell by 29% with dronedarone (33.36 vs. 47.19 events/100 patients, dronedarone vs. placebo). Based on the observed hospitalizations and derived costs, the overall cost savings with dronedarone were estimated at (mean ± SD) $1,328 ± 176 per patient (Table). The estimated savings in CV hospitalization costs (mean $1,341 per patient) heavily outweighed the added estimated AE hospitalization costs (mean $12 per patient). Sensitivity analysis showed the cost offset ranged between $594−$2,124 over 10,000 cycles of Monte Carlo simulation.
Conclusion: Dronedarone offers early cost benefits in AF/AFL, producing estimated mean hospital-related cost savings of $1328 per patient within the first 12 months of treatment in the ATHENA population.
| Hospitalization cause | Hospitalizations/100 patients1 | Default cost/hospitalization | Hospitalization cost saving/patient | |
Placebo + standard care | Dronedarone + standard care | |||
| Myocardial infarction/unstable angina | 3.14 | 1.69 | $17,360 | $250 |
| Cardiac arrhythmia & conduction disorders | 26.69 | 15.38 | $8,601 | $972 |
| Cardiovascular surgery | 2.58 | 2.52 | $21,233 | $12 |
| Worsening heart failure, pulmonary edema/cardiac dyspnea | 5.54 | 4.26 | $9,945 | $128 |
| Implantation of cardiac device | 2.15 | 1.69 | $18,272 | $83 |
| Transient ischemic attack/stroke | 1.59 | 1.30 | $9,006 | $26 |
| Other cardiovascular2 | 5.50 | 6.52 | $12,807 | −$130 |
| Total cardiovascular hospitalizations | 47.19 | 33.36 | − | $1,341 |
| Adverse events3 | 0.21 | 0.48 | $4,681 | −$12 |
| All hospitalization events | 47.40 | 33.84 | − | $1,328 |
| 1. Numbers rounded from 3 decimal places; 2. Cardiac transplantation, cardiovascular infection, pulmonary embolism/deep vein thrombosis, non-fatal cardiac arrest, major bleeding, atherosclerosis-related, syncope, blood pressure-related, stable angina pectoris or atypical chest pain; 3. Non-cardiovascular and treatment-related. | ||||