Cost-Effectiveness of Rate- and Rhythm-Control Drugs for Treating Atrial Fibrillation in Korea
10.3349/ymj.2019.60.12.1157
- Author:
Min KIM
1
;
Woojin KIM
;
Changsoo KIM
;
Boyoung JOUNG
Author Information
1. Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. cby6908@yuhs.ac
- Publication Type:Original Article
- Keywords:
Atrial fibrillation;
drugs;
cost effectiveness;
QALY
- MeSH:
Amiodarone;
Atenolol;
Atrial Fibrillation;
Betaxolol;
Bisoprolol;
Compliance;
Cost-Benefit Analysis;
Diltiazem;
Flecainide;
Humans;
Insurance, Health;
Korea;
Markov Chains;
Mortality;
National Health Programs;
Propafenone;
Propranolol;
Quality-Adjusted Life Years;
Sotalol;
Verapamil
- From:Yonsei Medical Journal
2019;60(12):1157-1163
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Although the economic and mortality burden of atrial fibrillation (AF) is substantial, it remains unclear which treatment strategies for rate and rhythm control are most cost-effective. Consequently, economic factors can play an adjunctive role in guiding treatment selection. MATERIALS AND METHODS: We built a Markov chain Monte Carlo model using the Korean Health Insurance Review & Assessment Service database. Drugs for rate control and rhythm control in AF were analyzed. Cost-effective therapies were selected using a cost-effectiveness ratio, calculated by net cost and quality-adjusted life years (QALY). RESULTS: In the National Health Insurance Service data, 268149 patients with prevalent AF (age ≥18 years) were identified between January 1, 2013 and December 31, 2015. Among them, 212459 and 55690 patients were taking drugs for rate and rhythm control, respectively. Atenolol cost $714/QALY. Among the rate-control medications, the cost of propranolol was lowest at $487/QALY, while that of carvedilol was highest at $1363/QALY. Among the rhythm-control medications, the cost of pilsicainide was lowest at $638/QALY, while that of amiodarone was highest at $986/QALY. Flecainide and propafenone cost $834 and $830/QALY, respectively. The cost-effectiveness threshold of all drugs was lower than $30000/QALY. Compared with atenolol, the rate-control drugs propranolol, betaxolol, bevantolol, bisoprolol, diltiazem, and verapamil, as well as the rhythm-control drugs sotalol, pilsicainide, flecainide, propafenone, and dronedarone, showed better incremental cost-effectiveness ratios. CONCLUSION: Propranolol and pilsicainide appear to be cost-effective in patients with AF in Korea assuming that drug usage or compliance is the same.
