COST-EFFECTIVENESS OF INPATIENT INITIATION OF ANTIARRHYTHMIC THERAPY FOR SUPRAVENTRICULAR TACHYCARDIAS

This study assessed the cost effectiveness of inpatient antiarrhythmic therapy initiation for supraventricular tachycardias using a metaanal ysis of proarrhythmic risk and a decision analysis that compared inpat ient to outpatient therapy initiation. A MEDLINE search of trials of a ntiarrhythmic 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 we ighted average event rate, by sample size, was calculated and applied to a clinical decision model of therapy initiation in which patients w ere either hospitalized for 72 hours or treated as outpatients. Fifty- seven drug trials involving 2,822 patients met study criteria. Based o n a 72-hour weighted average event rate of 0.63% (95% confidence inter val, 0.2% to 1.2%), inpatient therapy initiation cost $19,231 per year of life saved far a 60-year-old patient with a normal life expectancy . Hospitalization remained cost effective when event rates and life ex pectancies were varied to model hypothetical clinical scenarios. For e xample, cost-effectiveness ratios for a 40-year-old without structural heart disease and a 60-year-old with structural heart disease were $3 7,510 and $33,310, respectively, per year of life saved. Thus, a 72-ho ur hospitalization for antiarrhythmic therapy initiation is cost effec tive for most patients with supraventricular tachycardias. (C) 1997 by Excerpta Medico, Inc.