Ancient drug could save NHS millions each year when treating older patients with heart conditions

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 atrial fibrillation 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 a common heart rhythm disorder called atrial fibrillation (AF) and symptoms of heart failure.

The RATE-AF trial, funded by the National Institute for Health and Care Research, 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.

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. 

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 Sue Jowett, Deputy Head of the Health Economics Unit at the University of Birmingham and corresponding author of the study

Professor Dipak Kotecha from the Department of Cardiovascular Sciences at the University of Birmingham and the 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."