Second Line Pharmacological Management of Paroxysmal and Persistent Atrial Fibrillation in France: A Cost Analysis

Abstract

Objectives Despite optimal pharmacological treatment a large proportion of patients with atrial fibrillation (Afib) are not arrhythmia-free, and remain at risk for complications such as stroke and cardiac morbidity. If first-line treatment fails, most patients receive second-line pharmacological treatment. The emergence of new technologies aimed at restoring and maintaining sinus rhythm, such as catheter ablation techniques, has increased the interest in the economic aspects of second-line pharmacological treatment. The objective was therefore to calculate the 5-year direct medical costs of second-line pharmacological management of paroxysmal and persistent Afib in France. Methods The analysis was based on clinical and economic literature and the input of cardiologists-electrophysiologists. The analysis included probabilities of stroke, sudden cardiac death, other cardiac and noncardiac death, direct medical costs of drugs, follow-up and complications from the healthcare payer's perspective. Included treatment strategies were (1) rhythm control with class Ic and III antiarrhythmics and (2) rate control, consisting of digoxin combined with a beta-blocker or calcium antagonist. Both strategies included aspirin or anticoagulation therapy. Results The average total 5-year cost of Afib was 16,539 Euro (FF 108,486) per patient. The result was stable to sensitivity analysis on incidence of stroke and type of stroke prevention. The main cost drivers were follow-up visits and hospitalizations and the cost of congestive heart failure. Both items being subject to some variation, they were submitted to sensitivity analysis showing minimal 5-year costs still over 14,483 Euro (FF 95,000). Conclusion Afib management places high demands on medical resources mainly through its complications and comorbidity.