Abstract 12552: Cost Effectiveness of Dronedarone and Standard Care Compared with Standard Care Alone: US Results of the ATHENA Life-Time Model
Background: The ATHENA trial randomized atrial fibrillation/flutter (AF/AFL) patients with ≥1 other cardiovascular (CV) risk factor to dronedarone + standard care (n=2,301) or placebo + standard care (n=2,327) and showed significant reductions in CV hospitalization (26%) and CV mortality (29%) favoring dronedarone.
Objective: To assess the cost effectiveness of dronedarone from a US payer's perspective, using clinical data from ATHENA and published US mortality and cost data.
Methods: ATHENA patient data were applied to a health economic-state transition (Markov) model, with the following parallel health states: on/off antiarrhythmic treatment, symptomatic AF recurrence, acute coronary syndrome, congestive heart failure (CHF), stroke and death. Probabilities of health state transitions were derived from the ATHENA data set; the risk of death was based on mortality data (CHF and stroke mortality rates were from published non-US sources, other CV mortality rates were from ATHENA, and non-CV mortality rates were from published US data). Associated costs used in the model (2010 values) were obtained from published sources. The base-case model assumed that patients were treated with dronedarone for the duration of ATHENA (mean 21 months) and followed over a life-time. Cost effectiveness, from the payer's perspective, was determined using Monte Carlo microsimulation and expressed as cost/quality adjusted life-year (QALY) gained and cost/life year gained (LYG).
Results: Dronedarone + standard care provided 0.11 QALY gained over standard care alone; cost/QALY was $19,520 and cost/LYG was $16,930. Patients at higher risk of stroke (CHADS2 scores 3-6 vs. 0) had lower cost/QALY than patients at lower risk ($9580-16,000 vs. $26,450). One-way sensitivity analysis indicated that cost/QALY was stable (<$30,000) across tested scenarios. Cost/QALY was highest in scenarios assuming lifetime dronedarone therapy, no CV mortality benefit, no cost associated with AF recurrence on standard care, and when discounting of 5% was compared with 0%.
Conclusions: Based on the results of a large, multicenter, randomized clinical trial (ATHENA), dronedarone is a cost-effective treatment option for AF in the US.
- Atrial fibrillation
- Atrial flutter
- Cardiovascular disease prevention
- Arrhythmias, treatment of
- © 2011 by American Heart Association, Inc.