OBJECTIVES: Atrial Fibrillation (AFib), an irregular heartbeat, increases risk for heart-related complications. Guidelines recommend antiarrhythmic drugs (AADs) to address AFib symptoms; however, their long-term use increases adverse event (AE) risks. Thus, a budget impact model (BIM) was developed evaluating the replacement of other AADs with dronedarone from a U.S. payer perspective.

METHODS: Using an incident-based approach over a 5-year time horizon, a BIM was developed in a hypothetical plan of 1,000,000 members, assuming 4.6% annual growth rate for incident AFib and 89% of patients treated by AADs within one year of diagnosis. Drug, administration, discount, copay, and AE-related costs were calculated and compared between dronedarone, individual AADs (amiodarone, sotalol, flecainide, propafenone, dofetilide), and a composite of AADs. Drug, administration, and AE costs were obtained from the literature and all costs were adjusted to 9/2021 U.S. dollars (USD). Withdrawal due to AEs, proarrhythmia, stroke, and AFib recurrence were included as AEs. Baseline utilization of individual AADs was derived from 2019-2021 data; projected utilization rates for dronedarone were assumed to increase over years 1-5 (up to 20%), while utilization for other AADs reduced proportionally each year. The budgetary consequences to a U.S. payer were summarized as total costs per member per month (PMPM) in USD. One-way sensitivity analysis (OWSA) evaluated the impact of individual parameters.

RESULTS: For dronedarone vs. the composite of AADs, PMPM decreased by $4.74, $10.81, $19.91, $29.02, and $35.09 at years 1, 2, 3, 4, and 5, respectively. PMPM cost savings of dronedarone were largely attributable to reduced risk for AEs. In OWSA, a 20% increase in market share of dronedarone over years 1 through 5 increased PMPM savings by 25.9% on average, while a 20% decrease in the annual cost of dronedarone increased PMPM savings by 23.7%.

CONCLUSIONS: Increasing use of dronedarone demonstrated incremental cost reduction over time.