Economic analysis of cost and effectiveness ratio of dronedarone versus other anti-arrhythmics in treatment of non-permanent atrial fibrillation

Atrial fibrillation is the most frequently occurring cardiac arrhythmia in the western world. It is primarily associated with an increased risk of stroke and heart failure, in turn leading to hospitalization and increased mortality. The societal burden of AF is furthermore expected to increase as a result of an ageing population, given that its prevalence is doubled with each advancing decade of age, from 0.5% at 50 to 59 years to almost 9% at 80 to 89 years. Any kind of structural heart disease may trigger a slow but progressive process of structural remodelling in both the ventricles and the atria. Structural remodeling results in electrical dissociation between muscle bundles and local conduction heterogeneities facilitating the initiation and perpetuation of AF. This permits multiple small re-entrant circuits that can stabilize the arrhythmia. The main aims of treatment for atrial fibrillation are: to suppress paroxysms of AF and maintain long-term sinus rhythm; to control heart rate during paroxysms of AF if they occur; to prevent the complications associated with paroxysmal atrial fibrillation, ie stroke- and tachycardiainduced cardiomyopathy. Modeling in pharmacoeconomy is very important when it comes to chronic diseases such as atrial fibrillation, but also in the field of introducing new drugs in everyday clinical practice. The introduction of new drugs often involves increased costs of treatment. Markov model offers the possibility of obtaining a set of results that reflect both the efficiency and profitability of the examined therapeutic options. Using certain set of options in model we can determine how final decision will be change in the function of time and explore which parameters may have the greatest impact on the final decision which is obtained by modeling. The aim of this study was to compare cost-effectiveness of new anti-arhythmic drug dronedarone with amiodarone, propafenone and sotalol in patients with with non-permanent atrial fibrillation, based on data in Serbia. For purpose of modeling we obtained data on the effectiveness of the examined therapeutic options from available and valid literature and data on economic issues reflect the current economic situation in Serbia. Modeling requires support of TreeAge® Pro software. Results of our model indicate that dronedarone is cost effective therapy compared with amiodarone, propafenone and sotalol in patients with atrial fibrillation if the outcome is number of years spent without st