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[Economic evaluation of treatments of cardiac insufficiency]
1Service de pharmacologie clinique, Hôpital cardiologique, Lyon.
Insights
Angiotensin-converting enzyme (ACE) inhibitors improve cardiac failure outcomes but increase medication costs. However, cost-effectiveness analyses show these drugs are economical for severe cases due to reduced hospitalizations.
Area of Science:
- Cardiology
- Pharmacoeconomics
Context:
- Classical cardiac failure treatments focused on symptom relief.
- Modern therapies like ACE inhibitors improve survival but raise medication costs.
- An aging population and extended prescriptions increase the patient pool for cardiac failure treatments.
Purpose:
- To evaluate the cost-effectiveness of ACE inhibitors in cardiac failure management.
- To compare the economic impact of ACE inhibitors against traditional treatments.
- To determine the clinical and economic justification for ACE inhibitor use across different patient risk groups.
Summary:
- ACE inhibitors offer significant morbidity and mortality benefits in cardiac failure.
- While increasing direct drug costs, ACE inhibitors can lead to substantial savings through reduced hospital admissions and shorter stays.
- Cost-effectiveness analyses indicate ACE inhibitors are highly beneficial for severe cardiac failure, but may not be justified for low-risk patients.
Impact:
- ACE inhibitors represent a cost-effective strategy for managing cardiac failure, particularly in severe cases.
- Physicians must consider individual patient risk profiles to optimize ACE inhibitor prescription economically.
- The findings support the integration of ACE inhibitors into cardiac failure treatment guidelines while emphasizing judicious use.
Abstract:
The objective of classical treatments of cardiac failure (diuretics, digitalis) was to relieve patients' symptoms. Vasodilators and ACE inhibitors also improve morbidity and mortality. The introduction of the latter class of drugs for cardiac failure will, however, lead to a significant increase in the cost of medication at national level. These costs may increase even further in theory due to a predictable increase in the number of patients with cardiac failure (ageing of the general population, improved survival of cardiac patients) and due to the extension of prescription of these drugs to populations of subjects with cardiac failure hitherto relatively undertreated. On the other hand, economies may be realised in the management of cardiac failure related to fewer and shorter hospital admissions and reduced indirect costs or to the suppression of previous, less useful drugs (calcium antagonists, digitalis). Cost-effective analyses with ACE inhibitors carried out in different countries (Canada, netherlands) tend to show that the costs induced by prescription of these drugs are more than compensated by the economies realised by the reduction in hospital admissions. This is even more marked in the treatment of patients with severe cardiac failure. In subjects at low risk, the prescription of ACE inhibitors would not seem to be justified from both the clinical and economic points of view. It is up to each physician to decide the threshold of basic risk below which this treatment becomes "economically" acceptable.