Journal Article

Cost-Effectiveness of Antiarrhythmic Drugs for Treating Paroxysmal or Persistent Atrial Fibrillation in China: An Economic Evaluation

Xiao, Dunming, Chen, Yingyao, Weng, Junling, Liu, Shimeng, Li, Fuming, Xia, Yu

2025

Overview

•Dronedarone was a cost-effective AAD compared to amiodarone or sotalol for patients with paroxysmal or persistent AF in China.•The incremental cost associated with dronedarone was effectively offset by cumulative benefits in life expectancy and QALY in the long-term rhythm control.•Cost-effectiveness results highlighting the economic value of adopting dronedarone as an alternative first-line AAD option. Antiarrhythmic drug (AAD) therapies are foundational in the long-term management of atrial fibrillation (AF), yet there remains uncertainty in clinical and reimbursement decisions in China. This study aimed to estimate the cost-effectiveness of dronedarone compare to amiodarone and sotalol for the treatment of paroxysmal or persistent AF in China from the health system perspective. A Markov decision model was developed to compare the lifetime clinical efficacy and costs of three AAD therapies associated with AF recurrence, congestive heart failure, strokes, and deaths due to AF or AF related complications. Model inputs were derived from the ATHENA trial results, real-world database, published literature, and supplemented from expert opinion. Cost-effectiveness was measured by the incremental cost-effectiveness ratio (ICER), defined as the incremental cost per quality-adjusted life year (QALY) gained among groups. One-way sensitivity, probabilistic sensitivity, and scenario analyses were performed to explore the uncertainty of the model. This study used a simulated cohort with baseline characteristics of patients from the CCC-AF project. In the base case, compared to amiodarone and sotalol, dronedarone was expected to gain additional 1.28 QALYs (5.15 vs 3.87) and 1.78 QALYs (5.15 vs 3.37), with higher costs of $6632 ($11,025 vs $4393) and $6278 ($11,025 vs $4748) over a lifetime horizon, leading to ICERs of $5166 and $3524 per QALY, respectively. One-way sensitivity analysis revealed that the results were most sensitive to the relative risk of cardiovascular mortality, the discount rate of QALYs, and the utility for sinus rhythm. The probabilistic sensitivity analyses indicated that the probability of cost-effectiveness for dronedarone ranged from 97.0% to 99.4% at the threshold of one to three times China’s per capita gross domestic product in 2023, whereas the probability for amiodarone ranged from 3.0% to <1%, and for sotalol was always <1%. Scenario analyses confirmed that the base-case results were sufficiently reliable. Our analysis suggests that dronedarone is a cost-effective AAD compared to amiodarone and sotalol for patients with paroxysmal or persistent AF in China, offering improvements in life expectancy and QALY in the long-term rhythm control.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aged / Amiodarone / Amiodarone - analogs & derivatives / Amiodarone - economics / Amiodarone - therapeutic use / Anti-Arrhythmia Agents - economics / Anti-Arrhythmia Agents - therapeutic use / Antiarrhythmic drug / Antiarrhythmics / Arrhythmia / Atrial fibrillation / Atrial Fibrillation - complications / Atrial Fibrillation - drug therapy / Atrial Fibrillation - economics / Atrial Fibrillation - mortality / Cardiac arrhythmia / Cardiology / Cardiovascular disease / Cardiovascular diseases / China / Clinical medicine / Congestive heart failure / Cost analysis / Cost-Benefit Analysis / Cost-effectiveness analysis / Dronedarone / Female / Fibrillation / GDP / Gross Domestic Product / Heart failure / Humans / Internal Medicine / Life span / Male / Markov Chains / Mortality / Patients / Quality-Adjusted Life Years / Rhythm control / Sensitivity analysis / Sinuses / Sotalol - economics / Sotalol - therapeutic use / Standard of care / Stroke / Toxicity