This study assessed the cost effectiveness of inpatient antiarrhythmic therapy initiation for supraventricular tachycardias using a metaanalysis of proarrhythmic risk and a decision analysis that compared inpatient to outpatient therapy initiation.
A MEDUNE search of trials of antiarrhythmic therapy for supraventricular tachycardias was performed, and episodes of cardiac arrest, sudden or unexplained death, syncope, and sustained or unstable ventricular arrhythmias were recorded.
A weighted average event rate, by sample size, was calculated and applied to a clinical decision model of therapy initiation in which patients were either hospitalized for 72 hours or treated as outpatients.
Fifty-seven drug trials involving 2,822 patients met study criteria.
Based on a 72-hour weighted average event rate of 0.63% (95% confidence interval, 0.2% to 1.2%), inpatient therapy initiation cost $19,231 per year of life saved for a 60-year-old patient with a normal life expectancy.
Hospitalization remained cost effective when event rates and life expectancies were varied to model hypothetical clinical scenarios.
For example, cost-effectiveness ratios for a 40-year-old without structural heart disease and a 60-year-old with structural heart disease were $37,510 and $33,310, respectively, per year of life saved.
Thus, a 72-hour hospitalization for antiarrhythmic therapy initiation is cost effective for most patients with supraventricular tachycardias.
Mots-clés Pascal : Tachycardie paroxystique supraventriculaire, Antiarythmique, Analyse coût efficacité, Economie santé, Chimiothérapie, Traitement, Homme, Appareil circulatoire pathologie, Cardiopathie, Trouble rythme cardiaque, Trouble excitabilité
Mots-clés Pascal anglais : Paroxysmal supraventricular tachycardia, Antiarrhythmic agent, Cost efficiency analysis, Health economy, Chemotherapy, Treatment, Human, Cardiovascular disease, Heart disease, Arrhythmia, Excitability disorder
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0057205
Code Inist : 002B02F02. Création : 14/05/1998.