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Published on: February 26, 2013
Cost-effectiveness of digoxin versus beta blockers in permanent atrial fibrillation: the Rate Control Therapy
Zainab Abdali1, Karina V Bunting2,3, Samir Mehta4
1Health Economics Unit, School of Health Sciences, University of Birmingham, Birmingham, UK.
Insights
Digoxin is a cost-effective alternative to beta-blockers for heart rate control in permanent atrial fibrillation (AF). This treatment offers significant savings for the NHS with comparable quality of life.
Area of Science:
- Cardiology
- Health Economics
Background:
- Atrial fibrillation (AF) presents a growing challenge to healthcare systems.
- Heart rate control in permanent AF with heart failure symptoms requires effective management strategies.
Purpose of the Study:
- To compare the cost-effectiveness of digoxin versus beta-blockers for heart rate control in permanent AF patients with heart failure symptoms.
Main Methods:
- The RATE-AF trial was a randomized, open-label, blinded endpoint study comparing digoxin and beta-blockers.
- A 12-month trial-based cost-utility analysis from a healthcare perspective was conducted.
- Resource utilization and patient-reported quality of life (QALYs) were prospectively collected.
Main Results:
- Digoxin treatment was significantly less costly (£530.41 per patient/year savings) due to fewer adverse events and reduced healthcare utilization.
- No significant difference in quality-adjusted life years (QALYs) was observed between the two treatments.
- Digoxin demonstrated a 94% probability of being cost-effective, with potential NHS savings of £102 million annually.
Conclusions:
- Digoxin is a less costly option for heart rate control in suitable permanent AF patients compared to beta-blockers.
- Larger cost-effectiveness studies are recommended to inform national and global healthcare policies.
Background:
Atrial fibrillation (AF) is a major and increasing burden on health services. This study aimed to evaluate the cost-effectiveness of digoxin versus beta-blockers for heart rate control in patients with permanent AF and symptoms of heart failure.
Methods:
RAte control Therapy Evaluation in permanent Atrial Fibrillation (RATE-AF) was a randomised, open-label, blinded, endpoint trial embedded in the UK National Health Service (NHS) to directly compare low-dose digoxin with beta-blockers (ClinicalTrials.gov: NCT02391337). A trial-based cost-utility analysis was performed from a healthcare perspective over 12 months. Resource use in primary and secondary healthcare services, medications and patient-reported quality of life were prospectively collected to estimate differences in costs and quality-adjusted life years (QALYs).
Results:
RATE-AF randomised 160 patients with mean age of 76 (SD 8) years and 46% women, of which 149 patients (n=73 digoxin, n=76 beta blockers) had complete data and survived to 12-month follow-up. Treatment with digoxin was significantly less costly, with a mean saving of £530.41 per patient per year (95% CI -£848.06 to -£249.38, p=0.001). This was principally due to substantially lower rates of adverse events, with less primary and secondary healthcare utilisation compared with beta-blocker therapy. There was no significant difference in QALYs (0.013; 95% CI -0.033 to 0.052, p=0.56). At the £20 000 per-QALY willingness to pay threshold, the probability of digoxin being cost-effective compared with beta-blockers was 94%, with potential annual savings to the NHS of £102 million/year (95% CI £48 million to £164 million saving, p=0.001).
Conclusions:
Digoxin is a less costly option when compared with beta-blockers for control of heart rate in suitable patients with permanent AF, with larger cost-effectiveness studies warranted to advise on national and global policy-making.
Trial Registration Number:
NCT02391337, EudraCT 2015-005043-13.
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