PURPOSE: This analysis estimated the cost effectiveness of esmolol, metoprolol, diltiazem and amiodarone for the treatment of supraventricular tachycardia (SVT) in perioperative or other emergent circumstances.
METHODS: A decision tree model was built to examine the cost effectiveness of esmolol, metoprolol, diltiazem and amiodarone for the treatment of SVT in perioperative or other emergent circumstances from a hospital perspective. Publically available wholesale acquisition costs (WAC) were used for pharmacy costs. Literature based values were used for most clinical inputs and medical costs of adverse cardiac events including myocardial infarction, stroke, hypotension, bradycardia, and ischemia. The primary efficacy parameter was rate of successful heart rate control. The primary outcome was the cost per successful heart rate control with incremental cost effectiveness ratios (ICERs) calculated. No discounting was applied due to the short time frame of the analysis. One way sensitivity analyses were conducted to test the influence of each model input. For the probabilistic sensitivity analysis, a Monte Carlo simulation consisting of 1,000 simulations was conducted to test the joint uncertainty of all modeling parameters simultaneously.
RESULTS: The total cost of therapy was $1,250, $2,630, $2,280, and $1,560 for esmolol, metoprolol, diltiazem and amiodarone, respectively. The rate of successful heart rate control was 90% (esmolol), 64% (metoprolol), 90% (diltiazem) and 74% (amiodarone). The cost per successful heart rate control was $1,390 (esmolol), $4,110 (metoprolol), $2,530 (diltiazem), and $2,100 (amiodarone). In the cost-effectiveness comparison, esmolol was the least costly treatment and most effective treatment. In the probabilistic sensitivity analysis, esmolol had the lowest cost-effectiveness ratio in 99.6% of the simulations. In the one-way sensitivity analysis, the model was most sensitive to the cost of hypotension, the cost of bradycardia and the rate of myocardial infarction.
CONCLUSIONS: In this model, from the hospital perspective, esmolol was both the least costly and the most cost-effective treatment in comparison with metoprolol, diltiazem, and amiodarone in the treatment of SVT in perioperative or other emergent circumstances.
CLINICAL IMPLICATIONS: Esmolol is cost-effective in treating supraventricular tachycardia.
DISCLOSURE: Franklin Dexter: Consultant fee, speaker bureau, advisory committee, etc.: University of Iowa Department of Anesthesia, received payment from Baxter Healthcare for my participation in the research
Julia Yang: Employee: Employee of Baxter
Rashad Carlton: Consultant fee, speaker bureau, advisory committee, etc.: Employee of Xcenda, which received payment to conduct research on behalf of Baxter
Thomas Bramley: Consultant fee, speaker bureau, advisory committee, etc.: Employee of Xcenda, which received payment to conduct research on behalf of Baxter
George Harb: Employee: Baxter
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