薬経済学: オープンアクセス

Cost−effectiveness of Landiolol, an Ultra−short−acting Betablocker, for Treatment of Sepsis Related Tachyarrhythmia in Germany

Abstract

Günther Krumpl and Evelyn Walter*

Background: Sepsis and septic-shock are associated with cardiovascular problems, including tachyarrhythmia, myocardial injury, and changes in vascular endothelial function that might affect cardiac output with potential fatal outcome. The consequences of sepsis extend well beyond the acute illness. Tachycardia and new-onset atrial-fibrillation (AF), often treated with less effective agents such as amiodarone, are key prognostic factors for sepsis and associated with increased use of health-care resources and costs. Early decrease of heart-rate is associated with improved outcome. The use of β-blockers for managing acute arrhythmias in patients with septic-shock has been described in the literature. Landiolol, an ultra-short-acting β1-selective adrenergic-receptor-antagonist, is used specifically for the acute management of atrial-fibrillation and atrial-flutter in critically ill patients with/without cardiac-dysfunction.

Methods: A decision-model was developed to reflect the cost-effectiveness of landiolol in addition to conventional-therapy vs. standard-of-care (SoC) to manage sepsis-related tachyarrhythmia. The model combines a short-term decision tree to describe the time span of the sepsis related hospitalization over 28 days. The endpoint of the decision tree was then combined with a Markov model to simulate a life-long time horizon, as AF and post discharge mortality occurrence following sepsis hospitalization was more common among patients with new-onset AF during sepsis. The model calculates total costs (incl. hospital-stay, ICU and ventilation, AF costs) quality-adjusted life-years/QALYs and life-years/LYs over life-time.

Results: Manage sepsis related tachyarrhythmia with landiolol led to estimated lifetime costs of 59.130.79 € (95%-CI=53,436-64,901) per patient and 4.02 QALYs (5.56 LYs) over a life-time horizon. SOC was associated with 60.935.11 € (95%-CI=47,928-73,124) and 3.55 QALYs (5.01 LYs). Landiolol yields cost savings of about 1,804.31 € per patient and a QALY gain of 0.47 or 5.63 months in perfect health. Landiolol resulted in a life year gain of 0.54 LYs.

Conclusion: The economic analysis shows that the use of landiolol is associated with costs saving from the payer’s perspective.