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Cost-effectiveness of fixed-dose combination of isosorbide dinitrate and hydralazine therapy for blacks with heart

Derek C Angus1, Walter T Linde-Zwirble, S William Tam

  • 1Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA. angusdc@upmc.edu

Circulation
|December 14, 2005
PubMed

Insights

Fixed-dose isosorbide dinitrate/hydralazine (ISDN/HYD) reduced heart failure hospitalizations and healthcare costs in the A-HeFT trial. This therapy demonstrates a favorable cost-effectiveness profile for managing heart failure in African Americans.

Area of Science:

  • Cardiovascular Medicine
  • Health Economics
  • Pharmacoeconomics

Background:

  • The African-American Heart Failure Trial (A-HeFT) demonstrated improved clinical outcomes with fixed-dose isosorbide dinitrate/hydralazine (ISDN/HYD).
  • Resource utilization and cost-effectiveness of ISDN/HYD therapy in this specific population require assessment.

Purpose of the Study:

  • To evaluate the resource use, healthcare costs, and cost-effectiveness of ISDN/HYD therapy within the A-HeFT trial population.
  • To determine if ISDN/HYD therapy offers a favorable economic profile alongside its clinical benefits.

Main Methods:

  • Resource use data from the A-HeFT trial were analyzed using US federal cost sources.
  • Within-trial costs and cost-effectiveness were modeled over extended time horizons, including a US societal lifetime reference case.
  • Heart failure-related and total healthcare costs were compared between ISDN/HYD and placebo groups, excluding indirect costs.

Main Results:

  • The ISDN/HYD group experienced significantly fewer heart failure-related hospitalizations (0.33 vs. 0.47 per subject, P=0.002) and shorter hospital stays (6.7 vs. 7.9 days, P=0.006).
  • Excluding study drug costs, ISDN/HYD therapy was associated with lower mean per-subject heart failure-related costs ($5,997 vs. $9,144, P=0.04) and total healthcare costs ($15,384 vs. $19,728, P=0.03).
  • ISDN/HYD therapy was found to be dominant (reduced costs and improved outcomes) over the trial duration, with projected cost-effectiveness ranging from $16,600/life-year at 2 years to $41,800/life-year over a lifetime.

Conclusions:

  • ISDN/HYD therapy not only improves clinical outcomes but also significantly reduces resource use and healthcare costs in the A-HeFT population.
  • The primary driver for cost reduction was a substantial decrease in hospitalizations.
  • Long-term utilization of ISDN/HYD therapy is projected to have a favorable cost-effectiveness profile for this patient group.
Abstract

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