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Cost-effectiveness of digoxin, pacing, and direct current cardioversion for conversion of atrial flutter in neonates

Published online by Cambridge University Press:  06 March 2018

Deepa Prasad ,
Joni Steinberg  and
Christopher Snyder
Deepa Prasad*
Affiliation:
Division of Pediatric Cardiology, The Congenital Heart Collaborative, UH Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
Joni Steinberg
Affiliation:
Department of Global Health Management & Policy, Tulane University of Public Health and Tropical Medicine, New Orleans, LA, USA
Christopher Snyder
Affiliation:
Division of Pediatric Cardiology, The Congenital Heart Collaborative, UH Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
*
Author for correspondence: D. Prasad, MD, Pediatric Cardiologist, Cardon Children’s Medical Center, Mesa, AZ 85202, USA. Tel: 4804126336; Fax: 4804128013; E-mail: [email protected]
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Abstract

Introduction

Newborn atrial flutter can be treated by medications, pacing, or direct current cardioversion. The purpose is to compare the cost-effectiveness of digoxin, pacing, and direct current cardioversion for the treatment of atrial flutter in neonates.

Materials and methods

A decision tree model was developed comparing the efficacy and cost of digoxin, pacing, and direct current cardioversion based on a meta-analysis of published studies of success rates of cardioversion of neonatal atrial flutter (age<2 months). Patients who failed initial attempt at cardioversion progressed to the next methodology until successful. Data were analysed to assess the cost-effectiveness of these methods with cost estimates obtained from 2015 Medicare reimbursement rates.

Results

The cost analysis for cardioversion of atrial flutter found the most efficient method to be direct current cardioversion at a cost of $10 304, pacing was next at $11 086, and the least cost-effective was digoxin at $14 374. The majority of additional cost, regardless of method, was from additional neonatal ICU day either owing to digoxin loading or failure to covert. Direct current cardioversion remains the most cost-effective strategy by sensitivity analyses performed on pacing conversion rate and the cost of the neonatal ICU/day. Direct current cardioversion remains cost-effective until the assumed conversion rate is below 64.6%.

Conclusion

The most cost-efficient method of cardioverting a neonate with atrial flutter is direct current cardioversion. It has the highest success rates based on the meta-analysis, shorter length of stay in the neonatal ICU owing to its success, and results in cost-savings ranging from $800 to $4000 when compared with alternative approaches.

Keywords

Atrial flutterneonatesdirect current cardioversionpacingdigoxincost-effectiveness
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 5 , May 2018 , pp. 725 - 729
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Copyright
© Cambridge University Press 2018 

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