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11-04-2013 | Cardiology | Article

Guideline-directed HF therapy ‘saves money and lives’


Free abstract

medwireNews: Medical treatment of heart failure (HF) in line with current clinical guidelines is highly cost-effective and may even be cost-saving, study findings indicate.

The study also found that treatment with more than one drug offered the greatest gain in quality-adjusted life years (QALYs) for patients with HF and reduced ejection fraction.

"Our findings demonstrate the importance of prescribing these national guideline-directed medical therapies to patients with heart failure," said Gregg Fonarow (David Geffen School of Medicine, Los Angeles, California, USA), the study's lead author, in a press statement.

The study aimed to quantify the incremental cost-effectiveness ratio (ICER) of three evidence-based treatments - angiotensin converting enzyme inhibitors (ACEI), beta-blockers (BB), and aldosterone antagonists (AA) - for patients with New York Heart Association (NYHA) class II or III HF and an ejection fraction of 35% or less.

Using Markov modeling, Fonarow's team calculated the yearly probabilities of hospitalization and mortality associated with four treatment strategies: diuretics only; ACEI only; ACEI plus BB; and ACEI plus BB plus AA. For each strategy, patient data were derived from recent, large clinical trials.

Writing in the Journal of the American College of Cardiology, Fonarow et al report that treatment with ACEI alone or in combination with a BB was associated with lower costs and higher quality of life than treatment with diuretics alone.

Using an ACEI instead of a diuretic saved US$ 444 (€ 341), while using ACEI plus BB saved $ 33 (€ 25), they calculate.

The greatest gains in QALYs occurred when all three guideline-directed medications were provided, and the ICER of each additional drug was less than $ 1500 (€ 1151) per QALY, they note.

"Even in the most unfavorable situations, the ICER was less than $ 10,000 [€ 7677] per life-year gained," write Fonarow et al.

In a separate analysis, the team found that up to $ 14,000 (€ 10,750) could be spent over a patient's lifetime on HF disease management programs to improve medication adherence and still be highly cost-effective.

"Given the high healthcare value provided by these medical therapies for health failure, reducing patient costs for these medications or even providing a financial incentive to promote adherence is likely to be advantageous to patients as well as the health care system," the authors conclude.

"Further resources should be allocated to ensure full adherence to guideline directed medical therapies for heart failure patients to improve outcomes, provide high-value care, and minimize health care costs."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Joanna Lyford, Senior medwireNews Reporter

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