Cost-effectiveness analysis of propafenone and amiodarone for atrial fibrillation initial treatment

Resumo

Introduction: Atrial fibrillation is the most common sustained arrhythmia due to progressive prevalence given population aging. Its treatment must be constantly improved, also considering cost-effective therapies. Objectives: To determine cost-effectiveness and budget impact analysis of propafenone versus amiodarone in atrial fibrillation patients without structural heart disease in Brazilian Public and Private Healthcare System. Methods: Decision analytic model was designed to compare two treatment strategies. Study endpoint was “atrial fibrillation reversion with hospital admission”. Costs were valued in Brazilian Real (BRL) for 2009. Effectiveness data were taken from randomized controlled clinical trials through literature critical analysis. For budget impact analysis, total direct cost per patient was multiplied by population eligible for treatment. Results: Total 1-year cost per patient with amiodarone treatment was BRL 484.45, whereas with propafenone was BRL253.70 in the public healthcare system. These costs were BRL1,059.08 and BRL 832.69 in the private healthcare system, respectively. The budget impact analysis shows that a reduction of approximately BRL 29 million and BRL9 million a year in public and private healthcare system was estimated with the incorporation of propafenone into treatment of target population studied. Conclusion: The incorporation of propafenone into atrial fibrillation baseline treatment in patients without structural heart disease is able to restore the sinus rhythm in a shorter period of time and prevent increasing the number of hospital admissions. This model suggests that the use of propafenone could generate fewer costs in the short-term within public and private healthcare system.