Cost-Effectiveness of Dronedarone in Atrial Fibrillation: Results for Canada, Italy, Sweden, and Switzerland

Åkerborg, Örjan; Nilsson, Jonas; Bascle, S; Lindgren, Peter; Reynolds, Matthew R.

doi:10.1016/j.clinthera.2012.06.007

Cited by 10 publications

(13 citation statements)

References 22 publications

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“…The finding that cost-effectiveness is below current thresholds is consistent with the conclusions of a similar assessment of dronedarone in Canada, Italy, Sweden, and Switzerland, where the costs/QALY gained were €5828, €5873, €14,970, and €8554, respectively 25. Variation across countries is largely attributed to differences in treatment costs, which were markedly higher in the US and Sweden.…”

Section: Discussionsupporting

confidence: 84%

“…In the absence of US data, EuroHeart Survey data on the quality of life of patients with AF23 were converted to utility values24 as detailed in an assessment of dronedarone’s cost-effectiveness in Canada, Italy, Sweden, and Switzerland 25. Utility reductions, based on non-AF patient data,26,27 were applied until death for stroke and congestive heart failure and for 1 year in patients with acute coronary syndrome 28,29.…”

Section: Methodsmentioning

confidence: 99%

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Cost-effectiveness of dronedarone and standard of care compared with standard of care alone: US results of an ATHENA lifetime model

Reynolds¹,

Nilsson²,

Åkerborg³

et al. 2013

CEOR

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BackgroundThe first antiarrhythmic drug to demonstrate a reduced rate of cardiovascular hospitalization in atrial fibrillation/flutter (AF/AFL) patients was dronedarone in a placebo-controlled, double-blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular Hospitalization or death from any cause in patiENts with Atrial fibrillation/atrial flutter (ATHENA trial). The potential cost-effectiveness of dronedarone in this patient population has not been reported in a US context. This study assesses the cost-effectiveness of dronedarone from a US health care payers’ perspective.Methods and resultsATHENA patient data were applied to a patient-level health state transition model. Probabilities of health state transitions were derived from ATHENA and published data. Associated costs used in the model (2010 values) were obtained from published sources when trial data were not available. The base-case model assumed that patients were treated with dronedarone for the duration of ATHENA (mean 21 months) and were followed over a lifetime. Cost-effectiveness, from the payers’ perspective, was determined using a Monte Carlo microsimulation (1 million fictitious patients). Dronedarone plus standard care provided 0.13 life years gained (LYG), and 0.11 quality-adjusted life years (QALYs), over standard care alone; cost/QALY was $19,520 and cost/LYG was $16,930. Compared to lower risk patients, patients at higher risk of stroke (Congestive heart failure, history of Hypertension, Age ≥ 75 years, Diabetes mellitus, and past history of Stroke or transient ischemic attack (CHADS2) scores 3–6 versus 0) had a lower cost/QALY ($9580–$16,000 versus $26,450). Cost/QALY was highest in scenarios assuming lifetime dronedarone therapy, no cardiovascular mortality benefit, no cost associated with AF/AFL recurrence on standard care, and when discounting of 5% was compared with 0%.ConclusionsBy extrapolating the results of a large, multicenter, randomized clinical trial (ATHENA), this model suggests that dronedarone is a cost-effective treatment option for approved indications (paroxysmal/persistent AF/AFL) in the US.

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Section: Discussionsupporting

confidence: 84%

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of dronedarone and standard of care compared with standard of care alone: US results of an ATHENA lifetime model

Reynolds¹,

Nilsson²,

Åkerborg³

et al. 2013

CEOR

Self Cite

View full text Add to dashboard Cite

show abstract

“…Four sets of analyses were performed to reflect costs and treatment effects in Canada, Italy, Sweden and Switzerland [56]. This analysis was conducted in a newly defined patient population identified by the EMA to avoid the use of dronedarone in permanent AF patients resembling those in the PALLAS study.…”

Section: Cost--effectiveness Analysismentioning

confidence: 99%

Pharmacokinetic and pharmacodynamic profile of dronedarone, a new antiarrhythmic agent for the treatment of atrial fibrillation

Rosa

Bianco

Parodi

et al. 2014

Expert Opinion on Drug Metabolism & Toxicology

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Dronedarone is an interesting antiarrhythmic agent in well-selected groups of patients. It also has several other pleiotropic effects that may potentially be beneficial in clinical practice, such as the reduction of the risk of stroke and acute coronary syndromes. In addition, combination therapies such as those with dronedarone and ranolazine, currently being investigated in the HARMONY trial, may provide another interesting approach to increase the antiarrhythmic efficacy and further reduce the incidence of side effects. A better understanding of the mechanisms underlying dronedarone's pleiotropic actions is expected to facilitate the selection of patients benefiting from dronedarone, as well as the development of novel antiarrhythmic drugs for AF.

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“…We used these data to generate SF-6D utility weights using a standard algorithm, 35 and combined this information with existing evidence on the impact of procedural complications, drug-related adverse events, and stroke upon patients' QOL. 36,37 The utility weight associated with each health state was then multiplied by the mean time each patient spent in each health state to give overall QALYs for each treatment. The details of the utility weights used are described in the Supplementary material online, Appendix.…”

Section: Utility Datamentioning

confidence: 99%

Cost-effectiveness of cryoballoon ablation for the management of paroxysmal atrial fibrillation

Reynolds

Lamotte²,

Todd

et al. 2014

EP Europace

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Cost-Effectiveness of Dronedarone in Atrial Fibrillation: Results for Canada, Italy, Sweden, and Switzerland

Cited by 10 publications

References 22 publications

Cost-effectiveness of dronedarone and standard of care compared with standard of care alone: US results of an ATHENA lifetime model

Cost-effectiveness of dronedarone and standard of care compared with standard of care alone: US results of an ATHENA lifetime model

Pharmacokinetic and pharmacodynamic profile of dronedarone, a new antiarrhythmic agent for the treatment of atrial fibrillation

Cost-effectiveness of cryoballoon ablation for the management of paroxysmal atrial fibrillation

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