Cost Offset With Quadruple Therapy for Heart Failure.

Area of Science:

• Cardiology
• Health Economics
• Pharmacoeconomics

Background:

• Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) includes ARNI, beta-blockers, MRAs, and SGLT2i.
• While RCTs show GDMT reduces hospitalizations, the economic impact of full quadruple therapy post-hospitalization is not well-quantified.

Purpose of the Study:

• To estimate the 1-year healthcare cost offset and net cost of implementing quadruple GDMT after HFrEF hospitalization.

Main Methods:

• Economic evaluation using Medicare-linked data from the GWTG-HF registry (2016-2020).
• Included adults aged 65+ hospitalized with HFrEF, with 1-year post-discharge follow-up.
• Quadruple GDMT defined as concurrent ARNI, beta-blocker, MRA, and SGLT2i use at discharge, modeled using RCT data.

Main Results:

• The cohort comprised 50,598 older adults with HFrEF.
• Modeled quadruple GDMT reduced HF hospitalizations by 87% and all-cause hospitalizations by 61%.
• Projected reduction in hospitalization costs was $9780 annually per patient; net costs ranged from savings to $6347, with most regimens yielding net savings.

Conclusions:

• Healthcare costs for hospitalized HFrEF patients are substantial, driven by hospitalizations.
• Quadruple GDMT implementation meaningfully reduces hospitalization costs.
• This therapy often yields net savings after accounting for medication expenses.