Real-World Health Care Resource Utilization and Costs Associated With First-Line Dronedarone Versus First-Line Ablation in Adults With Atrial Fibrillation

Abstract

Background

Rhythm control therapy with antiarrhythmic drugs (AADs) or catheter ablation is recommended for treatment of atrial fibrillation (AF). The impact of first-line AAD therapy (including dronedarone) or ablation on health care resource utilization (HCRU) is unclear.

Methods

Optum's de-identified Clinformatics Data Mart Database (January 1, 2012 to January 31, 2022) was used to assess US adults with AF (within 1 year) and no prior AADs who received first-line dronedarone or first-line ablation (including non-dronedarone AADs then ablation within 90 days) using a comparative cohort design. Dronedarone and ablation cohorts were propensity score matched. HCRU and per-patient per-month (PPPM) payer costs were compared over 24-months' follow-up. Sensitivity analyses assessing first-line ablation with no prior AADs were conducted.

Results

Post-matching, dronedarone and ablation cohorts (n = 1440) were similar. Event rate ratios (ERR; [95% CI]) for inpatient (0.85 [0.77–0.93]), any outpatient (0.95 [0.94–0.96]), or emergency room (0.91 [0.85–0.97]) visits, or atrial tachyarrhythmia (ATA)/AF–related procedures (0.72 [0.71–0.74]) were significantly lower with first-line dronedarone versus ablation (all p < 0.01). Dronedarone was associated with reduced mean PPPM costs for total HCRU (−$2603), any outpatient visits (−$2401), and ATA/AF–related procedures (−$1880) versus ablation (all p < 0.01). In contrast to the primary analysis, sensitivity analyses showed no significant difference in ERR for all-cause inpatient or any outpatient visits, but dronedarone remained associated with significantly lower mean PPPM total costs.

Conclusion

Over 24-months' follow-up in patients with AF, first-line dronedarone was associated with comparable rates of inpatient/outpatient visits, and lower total payer costs compared with an ablation-based approach.