Cost-benefits of incorporating levosimendan into cardiac surgery practice: German base case

Mardiguian, Silvy; Kivikko, Matti; Heringlake, Matthias; Smare, Caitlin; Bertranou, Evelina; Apajasalo, M; Pollesello, Piero

doi:10.3111/13696998.2015.1136312

Cited by 5 publications

(5 citation statements)

References 33 publications

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“…Nonetheless few studies have performed similar analysis in the cardiac surgery setting. An economic evaluation has recently been published in which the cost savings of levosimendan have been analysed against the use of dobutamine in the short and long term in patients undergoing cardiac surgery from the German national health care register [8]. In the mentioned study, medication and postoperative complications were the clinical variables studied and the cost-benefit in terms of costs and LOS were evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study evaluated the cost-benefit of levosimendan compared to dobutamine in the perioperative of cardiac surgery in a national care register. In this study, medication and postoperative complications were the clinical variables analysed, and on the cost-benefit side, costs and days of stay were evaluated [8]. However, it has not been evaluated whether preconditioning with this drug is cost-effective.…”

Section: Introductionmentioning

confidence: 99%

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Preconditioning with levosimendan reduces postoperative low cardiac output in moderate-severe systolic dysfunction patients who will undergo elective coronary artery bypass graft surgery: a cost-effective strategy

Jiménez-Rivera

Álvarez-Castillo

Ferrer-Rodríguez

et al. 2020

J Cardiothorac Surg

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Background: Patients with moderate-severe systolic dysfunction undergoing coronary artery bypass graft have a higher incidence of postoperative low cardiac output. Preconditioning with levosimendan may be a useful strategy to prevent this complication. In this context, design cost-effective strategies like preconditioning with levosimendan may become necessary. Methods: In a sequential assignment of patients with Left Ventricle Ejection Fraction less than 40%, two strategies were compared in terms of cost-effectiveness: standard care (n = 41) versus preconditioning with Levosimendan (n = 13). The adverse effects studied included: postoperative new-onset atrial fibrillation, low cardiac output, renal failure and prolonged mechanical ventilation. The costs were evaluated using deterministic and probabilistic sensitivity analysis, and Monte Carlo simulations were performed. Results: Preconditioning with levosimendan in moderate to severe systolic dysfunction (Left Ventricle Ejection Fraction < 40%), was associated with a lower incidence of postoperative low cardiac output in elective coronary artery bypass graft surgery 2(15.4%) vs 25(61%) (P < 0.01) and lesser intensive care unit length of stay 2(1-4) vs 4(3-6) days (P = 0.03). Average cost on levosimendan group was 14,792€ while the average cost per patient without levosimendan was 17,007€. Patients with no complications represented 53.8% of the total in the levosimendan arm, as compared to 31.7% in the non-levosimendan arm. In all Montecarlo simulations for sensitivity analysis, use of levosimendan was less expensive and more effective.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preconditioning with levosimendan reduces postoperative low cardiac output in moderate-severe systolic dysfunction patients who will undergo elective coronary artery bypass graft surgery: a cost-effective strategy

Jiménez-Rivera

Álvarez-Castillo

Ferrer-Rodríguez

et al. 2020

J Cardiothorac Surg

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“…In a separate investigation, Mardiguian et al [73] used a two-part Markov model to conduct a cost-benefit comparison (from a hospital perspective) of levosimendan and dobutamine in the perioperative treatment of patients undergoing cardiac surgery who required inotropic support. Cost-benefits were evaluated in terms of costs and bed stays in the German healthcare system using 2014 drug prices and other relevant published information, with a 3% annual discount rate.…”

Section: Pharmaco-economic Perspectivesmentioning

confidence: 99%

“…Over a 1-year time horizon (the base-case analysis), fewer adverse events and shorter hospital LOS meant that the use of levosimendan was associated with cost savings of €4787 per patient compared with dobutamine [73].…”

Section: Pharmaco-economic Perspectivesmentioning

confidence: 99%

The inodilator levosimendan: 20 years of experience in various settings of cardiac care

Tritapepe¹,

Pollesello

Grossini³

2020

Medical Research Journal

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Levosimendan emerged in the 1990s as a first-in-class inotrope and vasodilator that enhances cardiac contractility by sensitizing the contractile response to cardiac troponin C and causes vasodilatation by opening potassium-dependent ATP channels on vascular smooth muscle cells. Since its clinical debut in 2000, it has established itself as a valuable resource in the management of acute decompensated heart failure and is one of very few successful medical innovations of its kind in that field in recent decades. Its pharmacology is notable for delivering inotropy without an increase in myocardial oxygen consumption and for an array of secondary ('pleiotropic') effects that include an anti-ischemic effect, pre-conditioning and post-conditioning and cardioprotective effects and anti-oxidative effects. Proceeding from those properties it has been proposed that in addition to its use in various scenarios of low cardiac output levosimendan may be beneficial in other conditions associated with acutely decompensated heart failure, including right ventricular failure, subarachnoid hemorrhage, and cardiogenic shock with multi-organ dysfunction. The potential of levosimendan for kidney protection in situations of the cardio-renal syndrome has been identified. Additional lines of investigation include the use of levosimendan for perioperative hemodynamic support, its administration as repeated intermittent infusions to sustain patients with advanced heart failure and its application in a range of critical care settings. Levosimendan has also provided a template and a starting point for the development of a new generation of cardio-active drugs and is currently being evaluated in advanced clinical trials for the management of pulmonary hypertension in patients with heart failure with preserved ejection fraction.

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“…Par ailleurs, l'administration de levosimendan est le plus souvent unique (une cure de 24 heures, ne nécessitant qu'un seul flacon chez l'enfant) alors que la prescription d'inotropes conventionnels est en général nécessaire pendant plusieurs jours (utilisation de plusieurs flacons). Ainsi, en Allemagne, le gain réalisé chez des patients adultes ayant eu une chirurgie cardiaque a été estimé à plus de 4000 euros par patient [64].…”

Section: Coût Du Traitementunclassified

Utilisation du levosimendan chez l’enfant

Séguéla

Tafer

Thambo

et al. 2016

Archives de Pédiatrie

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Cost-benefits of incorporating levosimendan into cardiac surgery practice: German base case

Cited by 5 publications

References 33 publications

Preconditioning with levosimendan reduces postoperative low cardiac output in moderate-severe systolic dysfunction patients who will undergo elective coronary artery bypass graft surgery: a cost-effective strategy

Preconditioning with levosimendan reduces postoperative low cardiac output in moderate-severe systolic dysfunction patients who will undergo elective coronary artery bypass graft surgery: a cost-effective strategy

The inodilator levosimendan: 20 years of experience in various settings of cardiac care

Utilisation du levosimendan chez l’enfant

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