Abstract 16188: A Comparative Analysis of Cost and Cost-effectiveness of Rhythm vs. Rate Control Strategies in the Treatment of Atrial Fibrillation Patients
Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with a prevalence of 5–6% in people aged 65 years rising to 10% in those aged 80 years and older. Currently there are two main strategies for the management of AF: the restoration and maintenance of sinus rhythm (rhythm control), and control of the ventricular response (rate control). The purpose of this study was to do a comparative analysis of cost and cost-effectiveness of the two strategies.
Methods: Patients were enrolled from 532 sites in 21 countries between May 2007 and April 2008 in the Registry on Cardiac Rhythm Disorders (RECORD AF). Resource use was obtained from the registry. Hospitalizations, complications and cardiovascular events were assigned a Diagnosis Related Group (DRG) and costs estimated by multiplying the relative weight of a DRG by the Medicare base rate in 2008 ($4,893). Outpatient procedures were assigned a CPT4 code for costing, and Redbook 2007 average wholesale price (AWP) was used to cost medications. Lifetime costs were estimated using average Medicare participant per capita expenditure in 2008 ($6,458). Quality adjusted life years (QALYs) were calculated by estimating life expectancy based on Framingham data and multiplying by utility scores from the EQ-5D. A propensity score was calculated and stabilized inverse probability weighting was used to weight both costs and QALYs to potentially control for baseline clinical differences between the therapeutic groups. Bootstrap analysis was used to compare costs and estimate incremental cost-effectiveness ratios (ICER). Lifetime costs and life expectancy were discounted 3%.
Results: Of 5,127 patients followed for 1 year, 3,325 (65%) had a valid propensity score with which to weight costs and life expectancies. Total discounted lifetime costs were $51,505 and $50,934, and discounted QALYs were 8.17 and 8.03 for rhythm and rate control respectively. The ICER was $3,977 with 0.87 probability of the ICER < $30,000.
Conclusions: Controlling for potential confounding factors in a non-randomized data base, rhythm control was cost-effective in comparison with rate control in the treatment of AF patients.
- © 2010 by American Heart Association, Inc.