THE COST-EFFECTIVENESS OF IBUTILIDE VERSUS ELECTRICAL CARDIOVERSION IN THE CONVERSION OF ATRIAL-FIBRILLATION AND FLUTTER TO NORMAL RHYTHM

Atrial fibrillation and atrial flutter are cardiac rhythm disorders th at are often symptomatic and may interfere with the heart's function, limiting its effectiveness. These arrhythmias are responsible for a la rge number of hospitalizations at a significant cost to the healthcare system, Electrical cardioversion (EC) is the most common nonpharmacol ogic intervention used to convert atrial fibrillation and atrial flutt er to normal rhythm, Electrical cardioversion is highly successful in converting patients to normal rhythm; however, it is more traumatic an d resource intensive than pharmacologic treatment, Recently, a new rap id-acting drug, ibutilide, was approved for the conversion of atrial f ibrillation and atrial flutter. Ibutilide is administered through intr avenous infusion and does not require anesthetization of the patient, as is required for EC. A decision-tree model was developed to estimate the cost-effectiveness of ibutilide therapy compared with EC therapy, Clinical outcomes were based on a phase III trial of ibutilide, and r esource use was based on the literature and physician clinical judgmen t. A stepped conversion regimen of first-line ibutilide followed by EC for patients who fail to convert is less expensive and has a higher c onversion rate than first-line EC, Sensitivity analysis shows that our results are robust to changes in cost and effectiveness estimates.