Cost-effectiveness of heart failure therapies

Abstract

Heart failure (HF) is a leading cause of morbidity and mortality worldwide. Management of HF involves accurate diagnosis and implementation of evidence-based treatment strategies. Costs related to the care of patients with HF have increased substantially over the past 2 decades, partly owing to new medications and diagnostic tests, increased rates of hospitalization, implantation of costly novel devices and, as the disease progresses, consideration for heart transplantation, mechanical circulatory support, and end-of-life care. Not surprisingly, HF places a huge burden on health-care systems, and widespread implementation of all potentially beneficial therapies for HF could prove unrealistic for many, if not all, nations. Cost-effectiveness analyses can help to quantify the relationship between clinical outcomes and the economic implications of available therapies. This Review is a critical overview of cost-effectiveness studies on key areas of HF management, involving pharmacological and nonpharmacological clinical therapies, including device-based and surgical therapeutic strategies.

Pulmonary artery pressure‐guided heart failure management: US cost‐effectiveness analyses using the results of the CHAMPION clinical trial

“…Management of HF with pharmacological therapies and implantable device therapy has been studied extensively to prove their clinical effectiveness 43. The ICERs for medical device therapy for HF patients are between US$10 900 and US$303 000/QALY, depending on the intervention considered.…”

“…Implantable cardioverter defibrillators (ICDs), CRT‐P pacemakers, and CRT‐D defibrillations have been evaluated in the HF population for which these devices are known to have clinical benefit. Cost‐effectiveness studies of ICDs are sensitive to the patient population selected in each individual trial, and ICERs vary from US$34 000 to > US$70 000 per QALY gained over a lifetime 43. ICERs across countries are variable due to variations in healthcare practices and prices.…”

CardioPulse Articles

“…1,2 In general, all analyses have suggested that three key factors drive value for money: battery longevity, duration of benefit, and age at implantation. Obviously, complications add cost to the overall equation.…”

Repetitive use of levosimendan in advanced heart failure: need for stronger evidence in a field in dire need of a useful therapy

“…1). Moreover, each successive hospitalization carries a higher probability of death [5], and impacts on health economics, due to the high costs of HF-related hospitalization [4,6,7].…”