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The following is a summary of “Cost-effectiveness of digoxin versus beta blockers in permanent atrial fibrillation: the Rate Control Therapy Evaluation in Permanent Atrial Fibrillation (RATE-AF) randomised trial,” published in the January 2025 issue of Cardiology by Abdali et al.
Researchers conducted a retrospective study to compare the cost-effectiveness of digoxin and beta-blockers for heart rate control in individuals with permanent atrial fibrillation (AF) and heart failure symptoms.
They carried out the RAte control Therapy Evaluation in permanent Atrial Fibrillation (RATE-AF) trial within the UK National Health Service (NHS) to compare low-dose digoxin and beta-blockers (ClinicalTrials.gov: NCT02391337). A trial-based cost-utility analysis was performed over 12 months from a healthcare perspective. Data on primary and secondary healthcare resource use, medications, and QoL were collected to assess cost and quality-adjusted life years (QALYs).
The results showed that RATE-AF randomized 160 individuals with a mean age of 76 years (SD 8), including 46% of women. Complete data were available for 149 individuals (n=73 digoxin, n=76 beta-blockers) who survived the 12-month follow-up. Digoxin treatment was significantly less costly, with an average annual saving of £530.41 per person (95% CI −£848.06 to −£249.38, P =0.001), mainly due to fewer adverse events and reduced healthcare utilization. There was no significant difference in QALYs (0.013; 95% CI −0.033 to 0.052, P =0.56). At the £20,000 per-QALY willingness-to-pay threshold, digoxin had a 94% probability of being cost-effective, with potential savings to the NHS of £102 million annually (95% CI £48 million to £164 million, P =0.001).
Investigators concluded that digoxin represents a potentially cost-effective alternative to beta-blockers for heart rate control in appropriate patients with permanent AF, although larger cost-effectiveness studies were necessary to inform national and global healthcare policy decisions.
Source: heart.bmj.com/content/early/2025/01/15/heartjnl-2024-324761
