Key result
In-patient oral sotalol dosing for atrial fibrillation is highly variable; a projected 1-day intravenous load suggests potential cost savings of $871 to $3803 compared to 2- or 3-day oral loads.
Why the study?
Variability in in-patient sotalol therapy for symptomatic AF exists, but its impact on in-hospital and 30-day costs and outcomes is unknown, as is the cost impact of intravenous sotalol.
What are the costs and clinical outcomes associated with variable in-patient sotalol dosing schedules in patients with atrial fibrillation?
Observational (n=133)
No
What are the costs and clinical outcomes associated with variable in-patient sotalol dosing schedules in patients with atrial fibrillation?
In-patient oral sotalol initiation is associated with variable lengths of stay and high daily costs, suggesting potential economic benefits for accelerated intravenous loading protocols.
Potential cost savings with IV sotalol loading should not yet change practice; leaves open randomized trials to confirm benefits in AF.
INTRODUCTION: There exists variability in the administration of in-patient sotalol therapy for symptomatic atrial fibrillation (AF). The impact of this variability on patient in-hospital and 30-day posthospitalization costs and outcomes is not known. Also, the cost impact of intravenous sotalol, which can accelerate drug loading to therapeutic levels, is unknown. METHODS: One hundred and thirty-three AF patients admitted for oral sotalol initiation at an Intermountain Healthcare Hospital from January 2017 to December 2018 were included. Patient and dosing characteristics were described descriptively and the impact of dosing schedule was correlated with daily hospital costs/clinical outcomes during the index hospitalization and for 30 days. The Centers for Medicare and Medicaid Services reimbursement for 3-day sotalol initiation is $9263.51. Projections of cost savings were made considering a 1-day load using intravenous sotalol that costs $2500.00 to administer. RESULTS: The average age was 70.3 ± 12.3 years and 60.2% were male with comorbidities of hypertension (83%), diabetes (36%), and coronary artery disease (53%). The mean ejection fraction was 59.9 ± 7.8% and the median corrected QT interval was 453.7 ± 37.6 ms before sotalol dosing. No ventricular arrhythmias developed, but bradycardia (<60 bpm) was observed in 37.6% of patients. The average length of stay was 3.9 ± 4.6 (median: 2.2) days. Postdischarge outcomes and rehospitalization rates stratified by length of stay were similar. The cost per day was estimated at $2931.55 (1. $2931.55, 2. $5863.10, 3. $8794.65, 4. $11 726.20). CONCLUSIONS: In-patient oral sotalol dosing is markedly variable and results in the potential of both cost gain and loss to a hospital. In consideration of estimated costs, there is the potential for $871.55 cost savings compared to a 2-day oral load and $3803.10 compared to a 3-day oral load.
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Varela et al. (2021) conducted an observational in Atrial fibrillation (n=133). In-patient sotalol dosing approaches was evaluated on Daily hospital costs and clinical outcomes during the index hospitalization and for 30 days. In-patient oral sotalol dosing for atrial fibrillation is highly variable; a projected 1-day intravenous load suggests potential cost savings of $871 to $3803 compared to 2- or 3-day oral loads.
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