Zarkin G A, Bala M V, Calingaert B, VanderLugt J T
Center for Economics Research, Research Triangle Institute, Research Triangle Park, NC 27709-2194, USA.
Am J Manag Care. 1997 Sep;3(9):1387-94.
Atrial fibrillation and atrial flutter are cardiac rhythm disorders that are often symptomatic and may interfere with the heart's function, limiting its effectiveness. These arrhythmias are responsible for a large number of hospitalizations at a significant cost to the healthcare system. Electrical cardioversion (EC) is the most common nonpharmacologic intervention used to convert atrial fibrillation and atrial flutter to normal rhythm. Electrical cardioversion is highly successful in converting patients to normal rhythm; however, it is more traumatic and resource intensive than pharmacologic treatment. Recently, a new rapid-acting drug, ibutilide, was approved for the conversion of atrial fibrillation and atrial flutter. Ibutilide is administered through intravenous infusion and does not require anesthetization of the patient, as is required for EC. A decision-tree model was developed to estimate the cost-effectiveness of ibutilide therapy compared with EC therapy. Clinical outcomes were based on a phase III trial of ibutilide, and resource use was based on the literature and physician clinical judgment. A stepped conversion regimen of first-line ibutilide followed by EC for patients who fail to convert is less expensive and has a higher conversion rate than first-line EC. Sensitivity analysis shows that our results are robust to changes in cost and effectiveness estimates.
心房颤动和心房扑动是心律失常疾病，通常有症状，可能会干扰心脏功能，降低其有效性。这些心律失常导致大量患者住院，给医疗系统带来巨大成本。电复律（EC）是将心房颤动和心房扑动转为正常心律最常用的非药物干预措施。电复律在将患者转为正常心律方面非常成功；然而，与药物治疗相比，它更具创伤性且资源消耗更大。最近，一种新型速效药物伊布利特被批准用于转复心房颤动和心房扑动。伊布利特通过静脉输注给药，不像电复律那样需要对患者进行麻醉。开发了一个决策树模型来评估伊布利特治疗与电复律治疗相比成本效益。临床结果基于伊布利特的一项III期试验，资源使用基于文献和医生的临床判断。对于未能转复的患者，采用一线伊布利特随后进行电复律的逐步转复方案比一线电复律成本更低且转复率更高敏感性分析表明，我们的结果对于成本和有效性估计的变化具有稳健性。
