Evaluation of the Impact of an Institution-Specific Dofetilide Initiation Protocol on Mean Hospital Length of Stay and Cost for Dofetilide Initiation

BACKGROUND: Dofetilide is a class III antiarrhythmic drug indicated for the conversion and maintenance of normal sinus rhythm in symptomatic patients with atrial fibrillation/atrial flutter. Delay in initiation of dofetilide therapy may increase the duration of hospitalization from two nights to three nights to complete US Food and Drug Administration-required monitoring. Therefore, substantial cost savings may be associated with implementation of an institution-specific dofetilide initiation protocol in order to reduce hospitalization to two nights. This could potentially be achieved through protocol-defined utilization of the option for a condensed dosing interval for the first three doses of dofetilide in order to ensure the administration of two doses on the first day of hospitalization. OBJECTIVE: The primary objective of this study was to assess the impact of an institution-specific dofetilide initiation protocol on mean hospital length of stay and cost for dofetilide initiation. METHODS: The study design was a retrospective review of 150 patients admitted to the Clement J. Zablocki Veterans Affairs Medical Center for the purpose of dofetilide initiation. Matching time periods of 18 months before and after implementation of the institution-specific dofetilide initiation protocol were used to randomly select 75 patients from each time period for comparison. RESULTS: A significant reduction in mean hospital length of stay of 0.56 nights post-implementation of the institution-specific dofetilide initiation protocol was identified (95% confidence interval 0.20–0.92; P = 0.0029). Assuming hospital adjusted expenses per inpatient day of US$1831–2413, a reduction in hospital length of stay of 0.56 nights resulted in estimated cost savings of US$1025–1351 per admission for dofetilide initiation. CONCLUSION: Implementation of an institution-specific dofetilide initiation protocol decreases mean hospital length of stay and cost for dofetilide initiation.