Effects of ACE Inhibitors on Heart Failure in The Netherlands

Abstract

A modelling approach is used to analyse the cost effectiveness of prescribing angiotensin converting enzyme (ACE) inhibitors, compared with standard practice, as first-line therapeutic agents in the treatment of heart failure in The Netherlands. Data concerning costs, incidence, prevalence and survival are used to construct an age-dependent semi-Markov-chain model. Two scenarios are compared. The first reflects the continuation of common practice. The second, containing assumptions made on the basis of results from randomised clinical trials, reflects the situation in which ACE inhibitors are given as first-line pharmacotherapy. Conditional on the estimates and assumptions made, it is shown that prescribing ACE inhibitors as first-line pharmacotherapy will improve survival by about 4% over the first 10 years, and will save about 17% in costs over the first 10 years. Sensitivity analysis shows the robustness of the conclusions to all major parameters.

The health care costs of heart failure in Sweden

“…The total cost was distributed over hospital care (67%), nursing home care (23%), drugs (6%), ambulatory care (4%), and surgery (, 1%) [17]. In France, the cost of heart failure in 1990 was fr.…”

Economic Evaluation of Cardiac Contractility Modulation (CCM) Therapy with the Optimizer IVs in the Management of Heart Failure Patients

“…and hospitalization 24, 28, 34-37, 40, 43-47 rates and it is not a surprise therefore that there are a few heart failure economic studies in the literature, where NYHA class is used to model disease progression in a similar way [48][49][50][51][52][53][54][55] . In this light it should be noted that NYHA assessment is the CCM studies was long enough to exclude transient placebo impacts due to the subjective assessment and the effect in this parameter is sustained throughout a year, so the reliance on the NYHA assessment seems proper and valid.…”

The Cost-Effective Way Forward for the Management of the Patient with Heart Failure

“…Heart failure is a common condition affecting approxi mately 3 million people in the USA and 1.9 million in Germany [1], In Sweden, the prevalence is approximately 1.5-3% of the population of the US and Europe [2], Approximately 50% of patients will present clinically in NYHA class I. 25% class II, 15% class III.…”

“…costs incurred due to the loss of production through absence from work, can be estimated by the 'friction estimation' approach [2]. This is calcu lated by determining the average time required to fill a vacancy left by the ill person multiplied by the economic output per laborer.…”

“…In a study in The Netherlands. 70% of the costs of treating heart failure were attributable to hospital ization [2]. The dramatic decrease in hospitalizations for heart failure secondary to ACE inhibitor treatment is shown in figure 4 [13].…”