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Global Cardiovascular Strategies
Arrhythmias and Health Economics
Nina Rehnqvist, MD, Sweden
National Board of Health and Welfare, Stockholm, Sweden
Proceedings on 13th International Congress
THE "NEW FRONTIERS" OF ARRHYTHMIAS 1998
Implanted Defibrillators
The annual number of implanted defibrillators has increased from 49 in 1993 to 112 in 1995. Patients in all ages are treated but some 90% of the patients are in ages above 44 years. The oldest patient was 84 years. In about 15 patients the defibrillator has to be exchanged each year. The main costs for treatment are apart from drug costs and costs for devices, the costs for hospitalization. In Sweden the total costs for inhospital somatic care is 57.100 million SEK. Conduction disorders are responsible for about 3400 admissions and there is no great variation over the last years. The mean duration of time in hospital is about 4 days with a median of 3. With an average daily cost in hospital of 2.600 SEK this is corresponding to 46 million SEK ie 0.1% of somatic inhospital costs. Tachyarrhythmias mainly in the form of supraventricular tachycardias are responsible for 26 714 admissions whereof 13 989 are men corresponding to 2% of all male admissions and 12 725 corresponding to 1.4% of female admissions. The mean duration of stay in these disorders is 3.4 days and median 2 days. The total cost is estimated to 139 million SEK (0.2%). Thus treatment for supraventricular arrhythmias is not a heavy burden on hospital costs. Atrial fibrillation and atrial flutter are seldom the main cause for admission but patients with heart failure have atrial fibrillation in 50% of the cases in older ages and in 40 000 admissions atrial fibrillation is the main or contributory cause. There is an even sex distribution in admissions due to atrial fibrillation and flutter. Ventricular fibrillation on the other hand is a much more common disorder in men than in women.
Conclusion
In conclusion, antiarrhythmic problems are fairly common in the population but do not lay a heavy burden on hospital costs. Costs for devices are not negligible but not a heavy burden either. Drug costs for antiarrhythmic treatment are decreasing for pure antiarrhythmic drugs and verapamil but an increase is noted for sotalol. This increase, however, is much less pronounced than for lipidlowering drugs and ACE inhibition. Within the country there is a wide variation between counties with respect to prescription of antiarrhythmic drugs. The highest prescription rate is 2-3 times the lowest rate. There are also variations within the country in pacemaker implantation rate in the order of 50%.
TABLE I - The table shows how the prescription of some drugs of cardiological interest has changed over time
Drug
DDD/1000 inhabitants
1985
1990
1993
1994
1995
1996
Antiarrhythmic
1.03
0.97
0.83
0.83
0.83
0.94
Sotalol
0.96
2.07
3.57
4.30
4.81
5.69
Verapamil
6.23
6.43
5.33
5.15
4.71
4.74
Digitalis
22.5
16.7
14.1
13.6
12.9
13.8
Lipidlowering
0.50
2.43
4.5
5.6
7.8
12.6
Antidiabetic
21.5
24.7
25.2
26.5
28.0
31.5
ACEI
1.1
12.7
22.1
26.1
29.2
35.8
ACEI = ACE-inhibition drugs.
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