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[Economic study of carvedilol in heart failure. A cost effectiveness study in France]
P Lévy1, J L Dubois-Randé, A Cohen-Solal
1LEGOS, université Paris-IX Dauphine, place du Maréchal-de-Lattre-de-Tassigny, 75775 Paris.
Insights
Carvedilol significantly reduces mortality and hospital admissions in heart failure patients. This heart failure treatment offers economic advantages, proving cost-effective with substantial savings in hospital expenses.
Area of Science:
- Cardiology
- Pharmacoeconomics
- Clinical Trials
Background:
- Heart failure (HF) poses a significant mortality and morbidity burden.
- Standard bitherapy, with or without digitalis, is the current treatment for HF.
- Carvedilol's efficacy in reducing mortality and hospital admissions in HF patients has been demonstrated in Phase III trials.
Purpose of the Study:
- To evaluate the cost-effectiveness of Carvedilol in the French healthcare system.
- To assess the economic impact of incorporating Carvedilol into standard HF treatment.
- To determine the cost per life saved and per additional year of life expectancy.
Main Methods:
- A cost-effectiveness analysis was conducted, extrapolating Phase III trial data to the French population.
- Direct medical costs (drugs, hospital admissions) were compared between strategies with and without Carvedilol.
- Hospital expenses were estimated using H.M.G. (Hospitalization-at-Home Management Group) at 1997-1998 values.
Main Results:
- The Carvedilol group incurred an increased cost of 767 FF per patient but achieved a 50% reduction in mortality.
- The cost-effectiveness was calculated at 17,040 FF per life saved and 2,130 FF per additional year of life expectancy.
- Analysis of AP-HP (Assistance Publique – Hôpitaux de Paris) data indicated a 4,425 FF reduction in hospital expenses, classifying Carvedilol as a cost-saving strategy.
Conclusions:
- Carvedilol is a cost-effective addition to standard heart failure therapy, significantly reducing mortality and hospitalizations.
- The drug presents a favorable economic profile, leading to overall cost savings within the healthcare system.
- Carvedilol offers a valuable therapeutic and economic benefit for patients with cardiac failure.
Abstract:
A programme of four phase III clinical trials carried out in the USA on 1094 patients showed that Carvedilol, associated with the usual bitherapy and eventually with digitalis, reduced the mortality and number of hospital admissions of patients with cardiac failure. These results, transposed to the French population, may be used to evaluate the economic advantages of Carvedilol by developing a cost-effectiveness study which consists in relating the direct expenses (drugs and hospital admissions) of each of the two strategies, with or without Carvedilol, to their respective mortalities. Hospital expenses were estimated with respect to the H.M.G. corresponding to each hospital stay at 1997-1998 values. The cost in the Carvedilol group was 2,823 FF per patient (including 1,491 FF for the drug itself) but 2,056 FF were economised in hospital expenses. With an increased cost of 767 FF but a 50% reduction in mortality corresponding to a difference in mortality of 45@1000, the cost-effectiveness of Carvedilol was 17,040 per life saved and 2,130 FF per additional year of life expectancy. A study of the sensitivity produced even more favourable results of Carvedilol. An evaluation of hospital expenses on the basis of AP-HP data indicates that the addition of Carvedilol is associated with a 4,425 FF reduction in hospital expenses, which makes it a cost saving strategy.