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Economics and Outcomes of Sotalol In-Patient Dosing Approaches in Patients with Atrial Fibrillation
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  • Daniel Varela,
  • Tyson Burnham,
  • Heidi May,
  • Tami Bair,
  • Benjamin Steinberg,
  • Joseph Muhlestein,
  • Jeffrey Anderson,
  • Kirk Knowlton,
  • Thomas Bunch
Daniel Varela
The University of Utah School of Medicine

Corresponding Author:[email protected]

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Tyson Burnham
The University of Utah School of Medicine
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Heidi May
Intermountain Medical Center
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Tami Bair
Intermountain Health Care
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Benjamin Steinberg
University of Utah
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Joseph Muhlestein
Intermountain Medical Center
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Jeffrey Anderson
Intermountain Medical Center
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Kirk Knowlton
Intermountain Medical Center
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Thomas Bunch
University of Utah School of Medicine
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Abstract

Background: There exists variability in the administration of inpatient sotalol therapy for symptomatic atrial fibrillation(AF). The impact of this variability on patient in-hospital and 30-day post-hospitalization costs and outcomes is not known. Also, the cost impact of intravenous sotalol, which can accelerate drug loading to therapeutic levels, is unknown. Methods: 133 AF patients admitted for sotalol initiation at an Intermountain Healthcare Hospital from January 2017-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 CMS reimbursement for 3-day sotalol initiation is $9,263.51. Projections of cost savings were made considering a 1-day load using intravenous sotalol that costs $2,500.00 to administer. Results: The average age was 70.3±12.3 years, 60.2% were male with comorbidities of: hypertension(83%), diabetes(36%), and coronary artery disease(53%). Mean ejection fraction was 59.9±7.8% and median QTc was 453.7±37.6 ms before sotalol. 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. Post-discharge outcomes and rehospitalization rates stratified by length of stay were similar. The cost per day was estimated at $2,931.55 (1:$2,931.55, 2:$5,863.10, 3:$8,794.65, 4:$11,726.20). Conclusions: Inpatient 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 $3,803.10 compared to a 3-day oral load.
27 Aug 2021Submitted to Journal of Cardiovascular Electrophysiology
27 Aug 2021Submission Checks Completed
27 Aug 2021Assigned to Editor
29 Aug 2021Reviewer(s) Assigned
11 Sep 2021Review(s) Completed, Editorial Evaluation Pending
13 Sep 2021Editorial Decision: Revise Minor
04 Oct 20211st Revision Received
20 Oct 2021Submission Checks Completed
20 Oct 2021Assigned to Editor
20 Oct 2021Reviewer(s) Assigned
21 Oct 2021Review(s) Completed, Editorial Evaluation Pending
22 Oct 2021Editorial Decision: Revise Minor
23 Oct 20212nd Revision Received
25 Oct 2021Submission Checks Completed
25 Oct 2021Assigned to Editor
25 Oct 2021Reviewer(s) Assigned
26 Oct 2021Review(s) Completed, Editorial Evaluation Pending
27 Oct 2021Editorial Decision: Accept
Mar 2022Published in Journal of Cardiovascular Electrophysiology volume 33 issue 3 on pages 333-342. 10.1111/jce.15342