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  • Title: Incremental cost-effectiveness of guideline-directed medical therapies for heart failure.
    Author: Banka G, Heidenreich PA, Fonarow GC.
    Journal: J Am Coll Cardiol; 2013 Apr 02; 61(13):1440-6. PubMed ID: 23433562.
    Abstract:
    OBJECTIVES: This study sought to quantify the incremental cost-effectiveness ratios (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). BACKGROUND: There are evidence-based, guideline-directed medical therapies for patients with HFrEF, but the incremental cost-effectiveness of these therapies has not been well studied using contemporary data. METHODS: A Markov model with lifetime horizon and two states, dead or alive, was created. We compared HFrEF patients treated with diuretic agents alone to three treatment arms: 1) ACEI therapy alone; 2) ACEI+BB; and 3) ACEI+BB+AldA. Sequential therapy was also analyzed. HF hospitalizations and mortality rates were based on representative studies. Costs of medications and inpatient and outpatient care were accounted for. RESULTS: Treatment with ACEI and ACEI+BB strictly dominated treatment with diuretics only (cost-saving). The greatest gains in quality-adjusted life-years occurred when all 3 guideline-directed medications were provided. The incremental cost-effectiveness ratio (ICER) of ACEI+BB+AldA versus ACEI+BB and ACEI+BB versus ACEI was <$1,500 per quality-adjusted life-year. The cost-savings in the ACEI and ACEI+BB cohorts compared to that with diuretics alone were $444 and $33, respectively. Assuming lower treatment costs and lower hospitalization rates in the ACEI+BB+AldA arm resulted in greater cost-savings. Even in the most unfavorable situations, the ICER was <$10,000 per life-year gained. CONCLUSIONS: Our analysis demonstrates that medical treatment of HFrEF is highly cost-effective and may even result in cost-savings. Greater efforts to ensure optimal adherence to guideline-directed medical therapy for HFrEF are warranted.
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