Real-World Health Care Resource Utilization and Costs Associated With First-Line Dronedarone Versus First-Line Ablation in Adults With Atrial Fibrillation

Background: Rhythm control therapy with antiarrhythmic drugs (AADs) or catheter ablation is recommended for treatment of atrial fibrillation (AF). The impact of first-line AAD therapy (including dronedarone) or ablation on health care resource utilization (HCRU) is unclear. Methods: Optum's de-identified Clinformatics Data Mart Database (January 1, 2012 to January 31, 2022) was used to assess US adults with AF (within 1 year) and no prior AADs who received first-line dronedarone or first-line ablation (including non-dronedarone AADs then ablation within 90 days) using a comparative cohort design. Dronedarone and ablation cohorts were propensity score matched. HCRU and per-patient per-month (PPPM) payer costs were compared over 24-months' follow-up. Sensitivity analyses assessing first-line ablation with no prior AADs were conducted. Results: Post-matching, dronedarone and ablation cohorts (n = 1440) were similar. Event rate ratios (ERR; [95% CI]) for inpatient (0.85 [0.77–0.93]), any outpatient (0.95 [0.94–0.96]), or emergency room (0.91 [0.85–0.97]) visits, or atrial tachyarrhythmia (ATA)/AF–related procedures (0.72 [0.71–0.74]) were significantly lower with first-line dronedarone versus ablation (all p < 0.01). Dronedarone was associated with reduced mean PPPM costs for total HCRU (−$2603), any outpatient visits (−$2401), and ATA/AF–related procedures (−$1880) versus ablation (all p < 0.01). In contrast to the primary analysis, sensitivity analyses showed no significant difference in ERR for all-cause inpatient or any outpatient visits, but dronedarone remained associated with significantly lower mean PPPM total costs. Conclusion: Over 24-months' follow-up in patients with AF, first-line dronedarone was associated with comparable rates of inpatient/outpatient visits, and lower total payer costs compared with an ablation-based approach.