The clinical and economic efficiency of treatment in patients with chronic heart failure

Abstract

Objective: to study the clinical and economic benefits of adding ivabradine to standard therapy for chronic heart failure (CHF). Subjects and methods. A clinical and economic analysis of the pharmacoeconomic efficacy of ivabradine (Coraxan Servier, France) in patients with CHF was made using the Markov simulation on the basis of the SHIFT trial. The cost-utility ratio (CUR) was calculated by the formula: CUR=DC/Ut, where DC is the direct cost of treatment; Ut is the cost utility expressed in life-years gained (LYG) and quality-adjusted life years (QALY). While calculating the latter, the model used the utility value derived in the SHIFT-PRO trial, by applying the EQ-5D questionnaire. Results. The monthly cost of standard pharmacotherapy was 799,14 rbl. per person. The treatment involving ivabradine cost 1807,77 rbl. The mean total direct cost for treating one patient was 64 741,09 and 47 647,83 rbl. in the ivabradine and placebo groups, respectively. The costs of hospital stay were ascertained to constitute 60% of all the direct costs in patients receiving standard therapy. On the contrary, addition of ivabradine to standard therapy allows avoidance of 309 admissions for worsening CHF, which permitted 23 709 879 rbl. to be saved. Reducing the costs of hospitalization enables one to spend 67% of the means for pharmacotherapy. Following a 10-year simulation period, the standard therapy remains more inexpensive than therapy involving ivabradine (74 585,31 rbl. per person versus 120 843,30 rbl per person) and ensures the lower cost of one LYG and one QALY. At the same time, the therapy added by ivabradine can prevent 1300 admissions for CHF and about 500 deaths per 10,000 patients over 10 years. This will lead to more life-years gained (4,277 LYGs on ivabradine therapy versus 4,083 LYGs on standard therapy), including quality-adjusted life years (3,031 QALYs on ivabradine therapy versus 2,839 QALYs on standard therapy). When ivabradine was added to standard therapy, the cost of one LYG was 238 443 rbl. and that of QALY was 240 927 rbl. Thus, the estimated medical intervention is a cost-effective investment. Conclusions: 1. To enhance the efficiency of CHF treatment with ivabradine causes a rational change in the cost structure. 2. To reduce the costs of hospitalizations and to change the cost structure provide a possibility of increasing those of qualitative therapy. 3. To incorporate ivabradine in therapy for systolic CHF can gain more additional life years, including quality-adjusted life years. 4. To increase expenses on therapy involving ivabradine per LYG is a cost-effective investment.