Cost effectiveness of inpatient initiation of antiarrhythmic therapy for supraventricular tachycardias

Grant R. Simons, Eric L. Eisenstein, Leslee J. Shaw, Daniel B. Mark, Edward L.C. Pritchett

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

This study assessed the cost effectiveness of inpatient antiarrhythmic therapy initiation for supraventricular tachycardias using a metaanalysis of proarrhythmic risk and a decision analysis that compared inpatient to outpatient therapy initiation. A MEDLINE search of trials of antiarrhythmic therapy for supraventricular tachycardias was performed, and episodes of cardiac arrest, sudden or unexplained death, syncope, and sustained or unstable ventricular arrhythmias were recorded. A weighted average event rate, by sample size, was calculated and applied to a clinical decision model of therapy initiation in which patients were either hospitalized for 72 hours or treated as outpatients. Fifty-seven drug trials involving 2,822 patients met study criteria. Based on a 72-hour weighted average event rate of 0.63% (95% confidence interval, 0.2% to 1.2%), inpatient therapy initiation cost $19,231 per year of life saved for a 60-year-old patient with a normal life expectancy. Hospitalization remained cost effective when event rates and life expectancies were varied to model hypothetical clinical scenarios. For example, cost-effectiveness ratios for a 40-year-old without structural heart disease and a 60-year-old with structural heart disease were $37,510 and $33,310, respectively, per year of life saved. Thus, a 72-hour hospitalization for antiarrhythmic therapy initiation is cost effective for most patients with supraventricular tachycardias.

Original languageEnglish
Pages (from-to)1551-1557
Number of pages7
JournalAmerican Journal of Cardiology
Volume80
Issue number12
DOIs
StatePublished - 15 Dec 1997
Externally publishedYes

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