Key result
Low-dose digoxin saves ~£530 annually vs beta-blockers in permanent AF with similar QALYs.
Why the study?
Atrial fibrillation imposes a major and growing burden on healthcare systems, prompting an evaluation of the cost-effectiveness of digoxin versus beta-blockers for heart rate control in permanent AF with heart failure symptoms.
Does low-dose digoxin reduce healthcare costs and improve quality-adjusted life years compared to beta-blockers in patients with permanent atrial fibrillation and heart failure symptoms?
RCT (n=160)
Open-label, blinded endpoint
Randomized
Does low-dose digoxin reduce healthcare costs and improve quality-adjusted life years compared to beta-blockers in patients with permanent atrial fibrillation and heart failure symptoms?
In patients with permanent AF and heart failure symptoms, low-dose digoxin is highly cost-effective compared to beta-blockers, primarily due to fewer adverse events and reduced healthcare utilization.
Answers are grounded in this paper and cite their sources.
Supports low-dose digoxin for cost savings in permanent AF rate control without QALY loss; extends RCT evidence on economic outcomes versus beta-blockers.
BACKGROUND: Atrial fibrillation (AF) is a major and increasing burden on health services. This study aimed to evaluate the cost-effectiveness of digoxin versus beta-blockers for heart rate control in patients with permanent AF and symptoms of heart failure. METHODS: RAte control Therapy Evaluation in permanent Atrial Fibrillation (RATE-AF) was a randomised, open-label, blinded, endpoint trial embedded in the UK National Health Service (NHS) to directly compare low-dose digoxin with beta-blockers (ClinicalTrials.gov: NCT02391337). A trial-based cost-utility analysis was performed from a healthcare perspective over 12 months. Resource use in primary and secondary healthcare services, medications and patient-reported quality of life were prospectively collected to estimate differences in costs and quality-adjusted life years (QALYs). RESULTS: RATE-AF randomised 160 patients with mean age of 76 (SD 8) years and 46% women, of which 149 patients (n=73 digoxin, n=76 beta blockers) had complete data and survived to 12-month follow-up. Treatment with digoxin was significantly less costly, with a mean saving of £530.41 per patient per year (95% CI -£848.06 to -£249.38, p=0.001). This was principally due to substantially lower rates of adverse events, with less primary and secondary healthcare utilisation compared with beta-blocker therapy. There was no significant difference in QALYs (0.013; 95% CI -0.033 to 0.052, p=0.56). At the £20 000 per-QALY willingness to pay threshold, the probability of digoxin being cost-effective compared with beta-blockers was 94%, with potential annual savings to the NHS of £102 million/year (95% CI £48 million to £164 million saving, p=0.001). CONCLUSIONS: Digoxin is a less costly option when compared with beta-blockers for control of heart rate in suitable patients with permanent AF, with larger cost-effectiveness studies warranted to advise on national and global policy-making. TRIAL REGISTRATION NUMBER: NCT02391337, EudraCT 2015-005043-13.
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Abdali et al. (2025) conducted an RCT in Permanent atrial fibrillation and symptoms of heart failure (n=160). Digoxin vs. Beta-blockers was evaluated on Differences in costs and quality-adjusted life years (QALYs) (Mean saving £530.41, 95% CI -848.06 to -249.38, p=0.001). Low-dose digoxin was significantly less costly than beta-blockers for heart rate control in permanent AF, with a mean saving of £530.41 per patient per year (P=0.001) and no difference in QALYs.
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