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240-year-old drug could save NHS £100m a year treating common heart rhythm disorder
Research theme
Thrombo-inflammation People involved
Thrombo-inflammation Theme Lead
A 240-year-old drug called digoxin could save the National Health Service (NHS) at least £100 million each year when treating older patients with a common heart rhythm disorder called atrial fibrillation (AF) and heart failure. This was compared to usual treatment with a beta-blocker according to a new study from the University of Birmingham, the city where digoxin was first used in 1785.
In a paper published in the journal Heart, researchers conducted an economic analysis on a clinical trial called RATE-AF to look at the differences between two widely used drugs for older patients with atrial fibrillation and symptoms of heart failure.
The RATE-AF trial, funded by the National Institute for Health and Care Research (NIHR) and led by researchers working with the NIHR Birmingham Biomedical Research Centre (BRC), included 160 patients and randomly assigned them to receive digoxin or beta-blockers for 12 months. An economic analysis was conducted to work out cost-effectiveness.
“This study confirms an important role for digoxin in the management of these patients, providing safe and cost-effective treatment.”
Professor Dipak Kotecha, chief investigator of the RATE-AF trial
Among the patients who received digoxin, there were substantially less adverse events than with beta-blockers, including lower rates of hospital admission and general practice reviews for heart health. This resulted in an average cost saving of £530 per-patient per-year with digoxin. Extrapolating these results to the UK NHS, the researchers identified a potential cost saving of £102 million per year, which represents nearly 6% saving on the £1.7 billion spent annually on atrial fibrillation.
Professor Sue Jowett, Deputy Head of the Health Economics Unit at the University of Birmingham and corresponding author of the study commented:
“This study highlights the importance of health economic assessments and the role they can play to deliver appropriate treatments within the health service. At the usual £20,000 per quality-adjusted life year threshold, the probability of digoxin being cost-effective compared to beta-blockers was 94%, which could lead to substantial savings if the trial results were adopted more broadly in this population.”
Professor Dipak Kotecha from the Department of Cardiovascular Sciences at the University of Birmingham, theme lead for the NIHR Birmingham BRC Thrombo-inflammation research theme, and chief investigator of the trial said:
“Heart conditions such as atrial fibrillation and heart failure are expected to double in prevalence over the next few decades, leading to a large burden on patients as well as substantial impact on health systems around the world. Despite being one of the oldest drugs in use for heart disease, this study confirms an important role for digoxin in the management of these patients, providing safe and cost-effective treatment.”
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Notes for editors
- For media enquiries please contact Tim Mayo, Press Office, University of Birmingham, tel: +44 (0)7815 607 157.
- The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, educators and more than 40,000 students from over 150 countries.
- England’s first civic university, the University of Birmingham is proud to be rooted in of one of the most dynamic and diverse cities in the country. A member of the Russell Group and a founding member of the Universitas 21 global network of research universities, the University of Birmingham has been changing the way the world works for more than a century.
- The University of Birmingham is a founding member of Birmingham Health Partners (BHP), a strategic alliance which transcends organisational boundaries to rapidly translate healthcare research findings into new diagnostics, drugs and devices for patients. Birmingham Health Partners is a strategic alliance between nine organisations who collaborate to bring healthcare innovations through to clinical application:
- University of Birmingham
- University Hospitals Birmingham NHS Foundation Trust
- Birmingham Women’s and Children’s Hospitals NHS Foundation Trust
- Aston University
- The Royal Orthopaedic Hospital NHS Foundation Trust
- Sandwell and West Birmingham Hospitals NHS Trust
- Health Innovation West Midlands
- Birmingham and Solihull Mental Health NHS Foundation Trust
- Birmingham Community Healthcare NHS Foundation Trust
About the National Institute for Health and Care Research
The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:
- Funding high quality, timely research that benefits the NHS, public health and social care;
- Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
- Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
- Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
- Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
- Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.
NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK international development funding from the UK government.
The National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre translates new scientific discoveries into treatments and diagnostics to improve people’s health in the UK and across the globe. We focus on inflammation, a common feature of many diseases, and work to improve its diagnosis, prevention and treatment. We are part of the NIHR and hosted by University Hospitals Birmingham NHS Foundation Trust in partnership with the University of Birmingham.
About the RATE-AF trial
Read the main findings from the RATE-AF trial: JAMA 2020
Other articles related to the RATE-AF trial: Cardiology, 2020; Heart 2021; Eur Heart J 2021; Nat Med 2024.
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