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Impact of dronedarone treatment on healthcare resource utilization in patients with atrial fibrillation/flutter
Michael H Kim1, Jay Lin, Mehul Jhaveri
1Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, 593 Eddy Street, APC 739, Providence, RI, USA, mkim4@lifespan.org.
Insights
Dronedarone significantly reduced hospitalizations and emergency visits for atrial fibrillation (AF) patients in real-world practice. While office visits and AF prescriptions increased, overall healthcare utilization decreased, supporting its effectiveness.
Area of Science:
- Cardiology
- Pharmacoeconomics
- Real-world evidence studies
Background:
- The ATHENA trial showed dronedarone reduced cardiovascular hospitalizations by 26% in atrial fibrillation/atrial flutter (AF/AFL) patients.
- ATHENA was the first trial to demonstrate a cardiovascular outcomes benefit with an antiarrhythmic drug.
- This study assessed dronedarone's impact on healthcare resource utilization in US clinical practice for AF/AFL patients.
Purpose of the Study:
- To evaluate the real-world healthcare resource utilization associated with dronedarone treatment in patients with AF/AFL.
- To compare pre- and post-dronedarone initiation healthcare resource utilization in a US patient cohort.
Main Methods:
- Retrospective cohort study using MarketScan® databases (June 2009–March 2011).
- Identified patients with ≥180 days of dronedarone supply, AF/AFL diagnosis, and no prior heart failure hospitalization.
- Compared annualized inpatient and outpatient resource utilization during pre-index (baseline) and post-index (follow-up) periods.
Main Results:
- 5,656 AF/AFL patients were prescribed dronedarone for ≥6 months, with a mean follow-up of 11.9 months.
- Significant reductions observed in annualized hospitalizations (all-cause, CV-, AF-related) by ~40-45% and ED visits by ~30-45%.
- Increases in office visits (~10-30%) and AF-related prescriptions (74%) were noted, but hospital and ED reductions were substantial.
Conclusions:
- Dronedarone use in real-world practice is associated with significant reductions in hospital admissions for AF/AFL patients.
- These findings align with the ATHENA trial, supporting dronedarone's efficacy in both first-line and second-line settings.
- Dronedarone demonstrates a favorable impact on healthcare resource utilization, primarily through decreased hospitalizations and emergency visits.
Background:
The ATHENA (A Placebo-Controlled, Double-Blind, Parallel Arm Trial to Assess the Efficacy of Dronedarone 400 mg bid for the Prevention of Cardiovascular Hospitalization or Death from Any Cause in Patients with Atrial Fibrillation/Atrial Flutter) trial demonstrated a significant reduction (26%) in the rate of first cardiovascular (CV) hospitalization in dronedarone-treated patients with paroxysmal or persistent atrial fibrillation/flutter (AF/AFL). ATHENA was the first trial to demonstrate a CV outcomes benefit, specifically reduced CV hospitalizations, with an antiarrhythmic drug. The objective of this study was to assess the impact of dronedarone treatment on healthcare resource utilization among real-world patients with AF/AFL in United States clinical practice.
Methods:
This retrospective cohort study used claims data from the MarketScan® databases (Truven Health, Durham, NC, USA) to identify patients with ≥2 concurrent de novo pharmacy claims for dronedarone (≥180 days' total supply) between June 2009 and March 2011, and with an AF/AFL diagnosis and no heart failure-related hospitalization during the 12 months preceding the initial (index) dronedarone claim. Annualized inpatient and outpatient resource utilization were compared between the pre-index (baseline) and post-index (follow-up) periods.
Results:
In total, 5,656 AF/AFL patients were prescribed dronedarone for ≥6 months and were followed for mean (standard deviation) 11.9 (4.7) months. Reductions in mean numbers of annualized all-cause, CV- and AF-related hospitalizations (~40-45%), and emergency department visits (~30-45%) were realized. These benefits were offset by increases in office visits (~10-30%) and AF-related prescription claims (74%) after dronedarone initiation. The sub-cohort of patients switching to dronedarone from Prior Rhythm-Control therapy (n=2,080) showed similar reductions in hospital and emergency department events.
Conclusions:
This study suggests that dronedarone use in real-world practice, as in the ATHENA trial, results in substantial reductions in hospital admissions, both in first-line and second-line antiarrhythmic treatment settings.
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