Economics and Outcomes of Sotalol In-Patient Dosing Approaches in
Patients with Atrial Fibrillation
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.