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There are evidence-based, guideline-directed medical therapies for HF with reduced ejection fraction (HFrEF), but their incremental cost-effectiveness has not been well studied using contemporary data.
Our objective was to quantify the incremental cost-effectiveness ratio (ICER) of angiotensin converting enzyme inhibitor (ACEI), beta-blocker (BB), and aldosterone antagonist (AldA) therapy for patients with HFrEF.
A Markov model with lifetime horizon and two states: dead or alive was created. We compared HFrEF patients treated with diuretics alone to three treatment arms: 1) ACEI 2) ACEI+BB 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.
Treatment with ACEI and ACEI+BB strictly dominated (cost-saving) treatment with diuretic only. 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 vs. ACEI+BB and ACEI+BB vs. ACEI was <$1500 per quality-adjusted life-year. The cost savings in the ACEI and ACEI+BB cohort compared to 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.
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 medical therapy for HFeEF are warranted.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Improving Heart Failure Outcomes II
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1200-103
- 2013 American College of Cardiology Foundation