A value-based budget impact model for dronedarone compared with other rhythm control strategies

Aim: The budgetary consequences of increasing dronedarone utilization for treatment of atrial fibrillation were evaluated from a US payer perspective. Materials & methods: A budget impact model over a 5-year time horizon was developed, including drug-related costs and risks for long-term clinical outcomes (LTCOs). Treatments included antiarrhythmic drugs (AADs; dronedarone, amiodarone, sotalol, propafenone, dofetilide, flecainide), rate control medications, and ablation. Direct comparisons and temporal and non-temporal combination scenarios investigating treatment order were analyzed as costs per patient per month (PPPM). Results: By projected year 5, costs PPPM for dronedarone versus other AADs decreased by $37.69 due to fewer LTCOs, treatment with dronedarone versus ablation or rate control medications + ablation resulted in cost savings ($359.94 and $370.54, respectively), and AADs placed before ablation decreased PPPM costs by $242 compared with ablation before AADs. Conclusion Increased dronedarone utilization demonstrated incremental cost reductions over time. Plain language summary What is this article about? Atrial fibrillation (AFib) is a common type of irregular heartbeat called arrhythmia, which may present with heart palpitations, shortness of breath, extreme fatigue, chest pain, and weakness. Guideline recommended treatment of AFib may include reducing the risk for stroke with anticoagulants, improving heartbeat irregularities with rate control medications or anti-arrhythmic drugs (AADs), and a minimally invasive surgery called ablation. This study assesses the budgetary consequences (costs) of increasing utilization of a specific AAD, dronedarone, in the treatment of AFib from a US payer's perspective. Comparative analysis explored different possible scenarios, including replacement of other AADs with dronedarone, dronedarone taken alone or in combination with ablation and/or rate control medications, and placing AADs earlier in the treatment sequence compared with ablation and rate control medications. What were the results? In the scenario replacing other AADs with dronedarone, there was a reduction in costs per patient per month (PPPM), largely related to lower risk for stroke with dronedarone. AADs placed before ablation in the treatment sequence also decreased PPPM costs compared with ablation placed before AADs. Use of AADs, individual or in combination with ablation, resulted in comparable clinical outcomes; however, there were overall cost savings because of the high procedural costs of ablation. What do the results mean? These findings can help payers make decisions about the most cost-effective treatment strategies for better results.