PCV40 Budget Impact Model After the Introduction of Vernakalant in Spain

Abstract

To estimate the hospital impact with the introduction of vernakalant in hospital emergency departments (EDs) in Spain. Patients with recent onset atrial fibrillation (AF) (<48H) or non-permanent AF without thromboembolic risk (anticoagulation or negative transesophageal echocardiography) were included in the ED setting. Scenario: Data derived from the RHYTHM-AF-Spain study or determined by the hospital. Budget impact model with the following variables: percentage of use of anti-arrhythmic drugs (AAD) before and after the entry of vernakalant, time to cardioversion with AAD and number of patients per year that could be treated with vernakalant. Outcome variables: impact on pharmacy budget, length of stay in ED (cost offset, additional patients treated in ED). Time to achieve sinus rhythm for vernakalant, drug cost, and hospital stay were obtained from published data. According to Spanish RHYTHM-AF study data, in 67% of these patients cardioversion (CV) is attempted with the following AAD (proportion; mean time to normal sinus rhythm): amiodarone iv (55%; 7 hours), flecainide iv/oral (12%/28%; 1.5/4.2 hours), propafenone iv/oral (1%/4%; 2/6.1 hours). It is estimated that in a hospital like those enrolled in RHYTHM-AF, approximately 150 patients per year would be admitted into the ED and pharma-cardioversion would be attempted in 101. Assuming that AADs were partially substituted for vernakalant (30% for amiodarone, 15% flecainide oral, 5% flecainide iv, and 5% propafenone oral), 22 patients would receive vernakalant per year. The annual incremental cost is €7,772.13, but offset in 63.4% due to a reduction of 123.16 hours of stay in the ED that would also allow for the assistance of 15 additional patients. The reduction of hospital stay associated with the use of vernakalant carries a high percentage of compensation costs associated with reduction of stay in the ED and frees up resources to attend to more patients.