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Hospital use and costs among patients with nonischemic cardiomyopathy in the first prospective randomized amlodipine
C M O'Connor1, P W Radensky, A N Unger
1Duke University Medical Center, Durham, North Carolina, USA.
Insights
Amlodipine treatment significantly delayed hospitalizations for patients with nonischemic cardiomyopathy. This calcium channel blocker may reduce hospital admissions for arrhythmias and offset its own cost through savings.
Area of Science:
- Cardiology
- Pharmacoeconomics
- Clinical Trials
Background:
- Nonischemic cardiomyopathy (NICM) poses significant healthcare utilization challenges.
- Assessing amlodipine's impact on hospitalization and costs in NICM is crucial for treatment guidelines.
Purpose of the Study:
- To evaluate amlodipine's effect on hospitalizations, length of stay, and per-diem costs in NICM patients.
- To compare hospitalization costs with amlodipine treatment expenses.
Main Methods:
- Analysis of 421 patients from the Prospective Randomized Amlodipine Survival Evaluation (PRAISE) study.
- Comparison of amlodipine (209 patients) versus placebo (212 patients) groups.
- Assessment of time to first hospitalization, admission rates, length of stay, and specific admission causes.
Main Results:
- Amlodipine significantly delayed time to first hospitalization (447 vs. 315 days, P=0.0139).
- Fewer amlodipine patients admitted for unexplained cardiac arrest (OR 0.235) and ventricular arrhythmias (OR 0.497).
- Amlodipine showed a trend towards reduced length of stay and lower costs, potentially offsetting treatment expenses.
Conclusions:
- Amlodipine delays hospitalization in NICM patients.
- Treatment may reduce admissions for arrhythmias and associated costs.
- Findings support amlodipine's role in managing severe heart failure due to nonischemic heart disease.
Abstract:
The incidence of hospitalizations, lengths of stay, and per-diem costs were determined for 421 patients (amlodipine, 209; placebo, 212) with nonischemic cardiomyopathy in the first Prospective Randomized Amlodipine Survival Evaluation (PRAISE) study to assess the impact of amlodipine on hospital use and to compare the costs of hospitalization with the cost of amlodipine treatment. Treatment with amlodipine versus placebo significantly delayed the mean (+/- SD) time to first hospitalization (447 +/- 26 d vs 315 +/- 18 d, respectively; P = 0.0139). Both treatment groups showed a similar number of hospital admissions per patient per year. The overall hospital length of stay was 1.17 days less per year with amlodipine than with placebo, at a cost of $1098 less per person per year although these differences were not statistically significant. Significantly fewer amlodipine patients were admitted for unexplained cardiac arrest (odds ratio, 0.235; P = 0.002) and ventricular arrhythmias (odds ratio, 0.497; P = 0.004). These findings are consistent with clinical reports from PRAISE of prolonged survival and a reduction in sudden cardiac death among patients with severe heart failure due to nonischemic heart disease. This analysis suggests that in patients with nonischemic cardiomyopathy, treatment with amlodipine can delay the time to hospitalization and may reduce the number of hospital admissions related to ventricular arrhythmias. The estimated reduction in hospital costs of $1098 per year would more than offset the amlodipine treatment cost of approximately $700 per year.