March 6, 2013
Heart Failure Treatment Extremely Cost-Effective When Guidelines Followed

Los Angeles—With increased availability of generic medications, guideline-based treatment of heart failure is highly cost-effective, according to a new study.

Even in less optimal circumstances, the incremental cost-effectiveness ratios (ICER) was less than $10,000 per life-year gained, according to the study appearing recently in the Journal of the American College of Cardiology.

Researchers from the Ahmanson-UCLA Cardiomyopathy Center sought to quantify the ICER of angiotensin-converting enzyme inhibitor (ACEI), beta-blocker (BB), and aldosterone antagonist (AldA) therapies for patients with heart failure with reduced ejection fraction (HFrEF).

HFrEF patients treated with diuretic agents alone were compared to three treatment arms of ACEI therapy alone; ACEI plus BB; and ACEI plus BB and AldA.

“The greatest gains in quality-adjusted life-years occurred when all three guideline-directed medications were provided,” the authors said; the ICER of the combination of all three therapies was less than $1,500 per quality-adjusted year of life. The results were similar when comparing the combination of the ACEI plus BB with just the ACEI.

When researchers assumed lower treatment expenses and lower hospitalization rates in patients taking all three drugs, significant cost-savings were realized. “Even in the most unfavorable situations,” the authors point out, “the ICER was <$10,000 per life-year gained.”

Background information in the article notes that heart failure remains one of the leading causes of mortality, morbidity, and health care–associated costs worldwide, with about 6 million Americans suffering from the condition. With more than a million heart failure admission a year, direct and indirect costs can exceed $39 billion a year.

Hospitalizations have been reduced with new therapies developed over the last 20 years, however. The authors point out that studies conducted even when the medications were still under patent showed substantial cost-effectiveness.

Now, with the lower cost of treatment, an additional $3,000 to $14,000 could be spent per patient, which would “still maintain an attractive ICER of $25,000 per life-year gained,” according to the authors.

“Further resources should be allocated to ensure full adherence to guideline-directed medical therapies for heart failure patients with reduced ejection fraction to improve outcomes, provide high-value care, and minimize health costs,” they conclude.

U.S. Pharmacist Social Connect