Cost-effectiveness of colchicine treatment on post-operative atrial fibrillation events in patients of major cardiac surgery

Abstract

Aims Post-operative atrial fibrillation (POAF) occurs in 20-50% of patients amid post-operative stay after Cardiac Surgery. We intend to determine whether colchicine therapy in patients undergoing cardiac surgery is a costeffective strategy for prevention of POAF. To undertake cost utility analysis and calculate incremental cost utility ratio (ICUR) for colchicine therapy in these subgroup of patients. Methods and results Design Decision tree model to calculate the ICUR comparing two treatment strategies in patients undergoing cardiac surgery. One wherein patients received colchicine along with usual care and second where they received placebo or just usual care. Cost utility analysis was undertaken using relevant data from the systematic review and metaanalysis of the available randomized controlled trials till June 2016 and mean cost calculations from validated available sources across various jurisdictions. Results Colchicine treatment based on mean costs for life expectancy calculated at 10 years' post-surgery using recommended discounting rates of 3.5% was e 17544.80 cheaper per quality-adjusted life-year (QALY) gained. The incremental cost is negative and the incremental effect (QALY) is positive (South East quadrant), Hence the intervention of colchicine treatment is unequivocally cost-effective, meaning it is dominant and achieves better outcomes at a lower cost. Conclusion Our findings provide a benchmark for current and future analyses relating to effectiveness of colchicine on POAF events after cardiac surgery. Currently, there are few reports that provide cutting edge estimates of the higher expenses associated with POAF. Future analyses should likewise explore the impact of added costs from using pharmacologic efforts to prevent and treat POAF after cardiac surgery.