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\begin{document}

\title{Economics and Outcomes of Sotalol In-Patient Dosing Approaches in
Patients with Atrial Fibrillation}



\author[1]{Daniel Varela}%
\author[1]{Tyson Burnham}%
\author[2]{Heidi May}%
\author[3]{Tami Bair}%
\author[4]{Benjamin Steinberg}%
\author[2]{Joseph Muhlestein}%
\author[2]{Jeffrey Anderson}%
\author[2]{Kirk Knowlton}%
\author[5]{Thomas Bunch}%
\affil[1]{The University of Utah School of Medicine}%
\affil[2]{Intermountain Medical Center}%
\affil[3]{Intermountain Health Care}%
\affil[4]{University of Utah}%
\affil[5]{University of Utah School of Medicine}%


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  \date{June 14, 2024}


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\begin{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\selectlanguage{ngerman}±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(\textless{}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.%
\end{abstract}\selectlanguage{ngerman}%



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\verb`Economics of Sotalol Dosing Approaches Final.docx`  available at \url{https://authorea.com/users/436482/articles/538769-economics-and-outcomes-of-sotalol-in-patient-dosing-approaches-in-patients-with-atrial-fibrillation}

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