Institute for Health Economics, Steinbeis-Hochschule-Berlin, Steinbeis-Haus, Gürtelstraße 29A/30, 10247, Berlin, Germany.
Pharmacoeconomics. 2013 Mar;31(3):195-213. doi: 10.1007/s40273-013-0028-7.
Atrial fibrillation (AF), a supraventricular tachycardia disorder, is the most common sustained cardiac arrhythmia affecting 1-2 % of the general population. Prevalence is highly related to age, with every fourth individual older than 40 years old developing AF during his lifetime. Due to an aging population, the prevalence of AF is estimated to at least double within the next 50 years. This article presents AF-related cost-of-illness studies and reviews 19 cost-effectiveness studies and six cost studies published roughly over the past decade, which have compared different antiarrhythmic medications for AF. A systematic literature search for studies published between June 2000 and December 2011 was conducted in PubMed using the combination of keywords ((atrial fibrillation OR atrial flutter) AND cost). Current cost-effectiveness analyses of dronedarone and the pill-in-the-pocket strategy are subject to substantial uncertainties with regard to clinical benefit. Comparing rate control with rhythm control, a cost-effectiveness advantage for rate control was shown in several but not all studies. Within antiarrhythmic drug treatments, magnesium added onto ibutilide was shown to be more cost effective than ibutilide alone. Comparing chemical and electrical cardioversion, the latter was recommended as more cost effective from the healthcare system perspective in all reviewed studies but one. Catheter ablation appeared more cost effective than antiarrhythmic drugs in the medium to long run after 3.2-63.9 years. Admissions to hospital, inpatient care and interventional procedures as well as mortality benefit are key drivers for the cost effectiveness of AF medications. No clear cost-effectiveness advantage emerged for one specific antiarrhythmic drug from the studies that compared antiarrhythmic agents. Rate control as well as catheter ablation appear more cost effective than rhythm control in the treatment of AF. Rate control treatment also seems more cost effective than electrical cardioversion in AF patients.
心房颤动（AF），一种室上性心动过速疾病，是最常见的持续性心律失常，影响 1-2%的普通人群。患病率与年龄高度相关，每四个 40 岁以上的人中就有一个在其一生中会发生 AF。由于人口老龄化，预计在未来 50 年内，AF 的患病率至少会增加一倍。本文介绍了与 AF 相关的疾病成本研究，并回顾了过去十年左右发表的 19 项成本效益研究和 6 项成本研究，这些研究比较了 AF 不同的抗心律失常药物。在 PubMed 中使用关键词组合（（心房颤动 OR 心房扑动）和成本）进行了 2000 年 6 月至 2011 年 12 月期间发表的研究的系统文献检索。目前，对决奈达隆和口袋药丸策略的成本效益分析在临床获益方面存在很大的不确定性。与节律控制相比，在一些但不是所有的研究中，速率控制显示出了成本效益优势。在抗心律失常药物治疗中，镁联合伊布利特比单独使用伊布利特更具成本效益。与化学和电复律相比，在所有回顾的研究中，但有一项除外，从医疗保健系统的角度来看，后一种方法被认为更具成本效益。在 3.2-63.9 年后的中短期，导管消融比抗心律失常药物更具成本效益。住院、住院护理和介入性手术以及死亡率获益是 AF 药物成本效益的关键驱动因素。从比较抗心律失常药物的研究中，没有一种特定的抗心律失常药物具有明显的成本效益优势。在 AF 的治疗中，速率控制以及导管消融比节律控制更具成本效益。在 AF 患者中，速率控制治疗似乎也比电复律更具成本效益。
