Clinical studyEconomic effects of beta-blocker therapy in patients with heart failure☆
Section snippets
Model
We developed a Markov model of heart failure progression based on the natural history of the disease (DATA 3.5; TreeAge Software, Inc., Williamstown, Massachusetts). The model included five health states: four New York Heart Association (NYHA) classes and death. A 5-year time horizon was modeled, with progression through states defined in 6-month cycles (Figure 1). Within each state, the model allowed for inpatient hospitalizations, outpatient service use, and medication use. Following
Modeled survival
Survival estimates produced by the decision model compared well with 4-year survival observed in the Digoxin trial (Figure 2). The maximum absolute difference between the survival curves was 2% (62% vs. 60% at 4 years). This correspondence suggests that the five-state Markov model with time-independent transition probabilities adequately represented disease progression for the study period.
Economic effects: baseline case
The estimated cost to society of treating a patient with heart failure without beta-blockers was $52,999
Discussion
Our results suggest that beta-blocker therapy is both clinically and financially beneficial over the long term from a societal standpoint. Similarly, beta-blockers would likely reduce Medicare expenditures for heart failure patients. The magnitude of savings would depend on the expense associated with increasing treatment adoption and adherence. There are no clear financial incentives for hospitals or providers to increase the use of beta-blockers among heart failure patients. Although patient
Acknowledgements
The authors would like to thank Wendy Gattis, PharmD, and Kevin Anstrom, PhD, for valuable input during model development, and Pamela Hale for editorial assistance.
References (37)
Economics of treating heart failure
Am J Cardiol
(1997)- et al.
Influence of carvedilol on hospitalizations in heart failureincidence, resource utilization and costs
J Am Coll Cardiol
(2001) - et al.
Long term adherence to evidence-based therapies for coronary artery disease and heart failure in the outpatient setting
J Am Coll Cardiol
(2003) - et al.
Costs and effects of enalapril therapy in patients with symptomatic heart failurean economic analysis of the Studies of Left Ventricular Dysfunction (SOLVD) treatment trial
J Card Fail
(1995) - et al.
Cost effectiveness of carvedilol for heart failure
Am J Cardiol
(1999) - et al.
Impact of a comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure
J Am Coll Cardiol
(1997) - et al.
Heart FailureEvaluation and Care of Patients with Left-Ventricular Systolic Dysfunction. Clinical Practice Guideline No. 11
(1994) - et al.
Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failurethe Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF)
JAMA
(2000) Effect of metoprolol CR/XL in chronic heart failureMetoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF)
Lancet
(1999)The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II)a randomised trial
Lancet
(1999)
When is it cost-effective to change the behavior of health professionals?
JAMA
Cost-effectiveness results from the US carvedilol heart failure trials program
Ann Pharmacother
Reduced costs with bisoprolol treatment for heart failurean economic analysis of the second Cardiac Insufficiency Bisoprolol Study (CIBIS-II)
Eur Heart J
Time preference
Economic impact of heart failure in the United Statestime for a different approach
J Heart Lung Transplant
Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions
N Engl J Med
Effect of amlodipine on morbidity and mortality in severe chronic heart failure
N Engl J Med
Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS)
N Engl J Med
Cited by (34)
Projecting the Long-term Clinical Value of Mavacamten for the Treatment of Obstructive Hypertrophic Cardiomyopathy in the United States: An Assessment of Net Health Benefit
2022, Clinical TherapeuticsCitation Excerpt :Third, NYHA functional class has been reported to be a significant predictor of all-cause and cardiovascular mortality among patients with HCM and thus can be linked to long-term survival.6,19–27 Fourth, NYHA functional class has been used to define health states in models of other cardiac diseases, such as heart failure.29–31 NYHA functional classes III and IV were combined into a single health state in the present model because few patients experienced NYHA functional class IV in EXPLORER-HCM (1 patient in the mavacamten arm at week 6 and 1 patient in the placebo arm at week 8), and no patient had experienced NYHA functional class IV in the EXPLORER-LTE cohort at the baseline, week 12, or week 48 assessments (cutoff date of October 30, 2020).16
Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model: A Web-based program designed to evaluate the cost-effectiveness of disease management programs in heart failure
2015, American Heart JournalCitation Excerpt :We believe ours to be the first generalizable simulation model developed to evaluate clinical and economic outcomes of patient-centered programs in heart failure. Previous models were developed to evaluate specific interventions and were structured using NYHA class3,21 or hospitalization counts as health states.22 Such models are not publicly available and cannot account for a broader range of factors that disease management programs may affect.
A Cost-Saving Strategy for Inpatient Management of Advanced Decompensated Heart Failure Patients: The Cardiomyopathy Unit
2009, Journal of Cardiac FailureStem cell and regenerative medicine: Commercial and pharmaceutical implications
2007, Artificial Cells, Cell Engineering and TherapyPatient-Reported Economic Burden and the Health Status of Heart Failure Patients
2006, Journal of Cardiac FailureCitation Excerpt :After adjusting for baseline characteristics that differed between groups, a similar trend was observed (Fig. 2, P = .2). Although much is known about the economic impact that HF has on society,3–7,10,13 few data14 exist to describe how patients' perceptions of their difficulties in affording health care affect their symptoms, functioning, and quality of life. Understanding this relationship is particularly important because evidence from clinical trials continues to define additional HF treatments that can potentially provide benefit of patients.10,11
Economic implications of extended-release metoprolol succinate for heart failure in the MERIT-HF trial: A US perspective of the MERIT-HF trial
2005, Journal of Cardiac FailureCitation Excerpt :Although ER metoprolol succinate has been considered in some of those analyses, only 1 included the MERIT-HF trial and all make projections of effect beyond the known data. In a recent analysis that constitutes the sole exception,26 results of MERIT-HF were pooled with those of other trials and combined with observational data from 1 hospital system to project results over 5 years. In that study, substantial savings to Medicare were predicted under all scenarios.
- ☆
Financial support for this study was provided by grant U18HS10548 (Duke Center for Education and Research on Therapeutics) from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Rockville, Maryland.