Supraventricular tachycardia: starting antiarrhythmics in hospital was more cost-effective than as an outpatient

Clinical bottom line (level 1b)

  1. Few patients started on antiarrhythmic therapy had a serious complication within the first 72 hours.
  2. Inpatient initiation of therapy was more cost-effective than outpatient initiation of therapy.
Simons et al: American Journal of Cardiology 1997; 80: 1551-1557
Expires October 2004

The study

cost-effectiveness study
Setting: university hospital, USA

Data obtained by using an English language Medline search (1966 to 1996) (using 'antiarrhythmia agents' and 'tachycardia, supraventricular' and 'atrial fibrillation' to find studies addressing monotherapy using quinidine, procainamide, disopyramide, mexiletine, flecainide, propafenone or d,l-sotalol for more than 48 hours. 57 trials involving 2822 patients were found. Information on mortality and non-lethal side-effects was combined in a clinical decision model comparing inpatient and outpatient initiation of therapy.

  • Viewpoint: HMO or NHS trust
  • Benefit assessment: increase in life expectancy, events (cardiac arrest, sudden death, sustained ventricular arrhythmias, syncope)
  • Resources and costs: Hospital and therapeutic costs taken from the accounting database of a US university hospital. Physicians' costs taken from the State Medicare reimbursement schedule.
  • Sensitivity analysis: variation in event rate and additional years of life gained. Unclear if costs were varied.

    • The evidence

    intervention cost
    cost per year of life saved $39969 to $68589

    Effect of sensitivity analysis: No change noted following sensitivity analysis.
    • Therapy was more cost-effective in younger patients.
    • Weighted 72 hour event rate (cardiac arrest, sudden or unexplained death, syncope, sustained or unstable ventricular arrhythmias): 0.63% (95% CI: 0.2% to 1.2%)

    Comments

    1. Outpatient events were assumed to be a 100% fatal.

    Citation

    1. Simons GR, Eisenstein EL, Shaw LJ, et al: Cost effectiveness of inpatient initiation of antiarrhythmic therapy for supraventricular tachycardias. American Journal of Cardiology 1997; 80: 1551-1557
    Contributor: Chris Ball and Bob Phillips, October 1999
    Reviewer:

    Clinical Question.
    Patient atrial fibrillation
    Intervention or Exposure commencing antiarrythmic therapy
    Outcome cost-effectiveness