A cost-effectiveness analysis of bisoprolol for heart failure

This study considers the cost-effectiveness of bisoprolol in heart failure patients as an adjunctive therapy to usual treatment.

A cost-effectiveness model was constructed using data available from the CIBIS I & II trials and other secondary sources. Differences in patient survival rates were calculated for bisoprolol (n=1327) and placebo groups (n=1320) extrapolating data over a 5-year period, under limited and extended benefits scenarios to calculate life years gained (LYG). Hospitalisation rates were calculated using data from both CIBIS trials. Costs were considered under two different patient management protocols for treatment initiation - shared care by outpatient clinics and GPs and initiation by a nurse working in the community. Discounted LYG were calculated to be 0.228 under the limited benefits scenario and 0.368 under the extended benefits scenario. Under the extended benefits scenario shared care resulted in a cost of pound268 per LYG or pound412 per LYG for community initiation. Under the limited benefits scenario the costs were a pound135 saving and pound69, respectively.

This analysis has shown bisoprolol to be an economically attractive therapy in comparison with other treatments. It is hoped that its adoption by clinicians will be rapid, despite the labour intensive and time consuming up-titration process involved in its initiation.