Greene Stephen J, Schilsky Samantha, Roberts Andrew W, Kabadi Shaum M, McKindley David S, Preblick Ron, Rashkin Jason, Leeming Reno C, Sajedian Renee M, Russo Andrea M
Duke University School of Medicine, Durham, North Carolina, USA.
Duke Clinical Research Institute, Durham, North Carolina, USA.
Clin Cardiol. 2025 Jun;48(6):e70145. doi: 10.1002/clc.70145.
Rhythm control therapy with antiarrhythmic drugs (AADs) or catheter ablation is recommended for treatment of atrial fibrillation (AF). The impact of first-line AAD therapy (including dronedarone) or ablation on health care resource utilization (HCRU) is unclear.
Optum's de-identified Clinformatics Data Mart Database (January 1, 2012 to January 31, 2022) was used to assess US adults with AF (within 1 year) and no prior AADs who received first-line dronedarone or first-line ablation (including non-dronedarone AADs then ablation within 90 days) using a comparative cohort design. Dronedarone and ablation cohorts were propensity score matched. HCRU and per-patient per-month (PPPM) payer costs were compared over 24-months' follow-up. Sensitivity analyses assessing first-line ablation with no prior AADs were conducted.
Post-matching, dronedarone and ablation cohorts (n = 1440) were similar. Event rate ratios (ERR; [95% CI]) for inpatient (0.85 [0.77-0.93]), any outpatient (0.95 [0.94-0.96]), or emergency room (0.91 [0.85-0.97]) visits, or atrial tachyarrhythmia (ATA)/AF-related procedures (0.72 [0.71-0.74]) were significantly lower with first-line dronedarone versus ablation (all p < 0.01). Dronedarone was associated with reduced mean PPPM costs for total HCRU (-$2603), any outpatient visits (-$2401), and ATA/AF-related procedures (-$1880) versus ablation (all p < 0.01). In contrast to the primary analysis, sensitivity analyses showed no significant difference in ERR for all-cause inpatient or any outpatient visits, but dronedarone remained associated with significantly lower mean PPPM total costs.
Over 24-months' follow-up in patients with AF, first-line dronedarone was associated with comparable rates of inpatient/outpatient visits, and lower total payer costs compared with an ablation-based approach.
推荐使用抗心律失常药物（AADs）或导管消融进行节律控制治疗心房颤动（AF）。一线AAD治疗（包括决奈达隆）或消融对医疗资源利用（HCRU）的影响尚不清楚。
使用Optum的去识别化临床信息数据集市数据库（2012年1月1日至2022年1月31日），采用比较队列设计，评估1年内患有AF且未使用过AADs的美国成年人，他们接受了一线决奈达隆治疗或一线消融治疗（包括非决奈达隆AADs治疗然后在90天内进行消融）。决奈达隆组和消融组进行倾向评分匹配。在24个月的随访期内比较HCRU和患者每月人均（PPPM）支付方成本。进行了评估未使用过AADs的一线消融治疗的敏感性分析。
匹配后，决奈达隆组和消融组（n = 1440）相似。与消融相比，一线决奈达隆治疗的住院（事件率比[ERR]；[95%CI]为0.85[0.77 - 0.93]）、任何门诊（0.95[0.94 - 0.96]）或急诊室就诊（0.91[0.85 - 0.97]）或房性快速性心律失常（ATA）/AF相关手术（0.72[0.71 - 0.74]）的事件率比显著更低（所有p < 0.01）。与消融相比，决奈达隆与降低总HCRU的平均PPPM成本（-2603美元）、任何门诊就诊（-2401美元）和ATA/AF相关手术（-1880美元）相关（所有p < 0.01）。与主要分析相反，敏感性分析显示全因住院或任何门诊就诊的ERR无显著差异，但决奈达隆仍与显著更低的平均PPPM总成本相关。
在AF患者24个月的随访中，与基于消融的方法相比，一线决奈达隆与可比的住院/门诊就诊率相关，且支付方总成本更低。
