Congestive Heart Failure| Volume 83, ISSUE 6, P890-896, March 15, 1999

Cost effectiveness of carvedilol for heart failure


      In this study, we examine the cost effectiveness of carvedilol for the treatment of chronic heart failure (CHF). We use a Markov model to project life expectancy and lifetime medical care costs for a hypothetical cohort of patients with CHF who were assumed alternatively to receive carvedilol plus conventional therapy (digoxin, diuretics, and angiotensin-converting enzyme inhibitors) or conventional therapy alone. Patients on carvedilol were assumed to experience a reduced risk of death and hospitalization for CHF, which is consistent with findings from the US Carvedilol Heart Failure Trials Program. The benefits of carvedilol were projected under 2 alternative scenarios. In the first (“limited benefits”), benefits were conservatively assumed to persist for 6 months, the average duration of follow-up in these clinical trials, and then end abruptly. In the other (“extended benefits”), they were arbitrarily assumed to persist for 6 months and then decline gradually over time, vanishing by the end of 3 years. We estimated our model using data from the US Carvedilol Heart Failure Trials Program and other sources. For patients receiving conventional therapy alone, estimated life expectancy was 6.67 years; corresponding figures for those also receiving carvedilol were 6.98 and 7.62 years under the limited and extended benefits scenarios, respectively. Expected lifetime costs of CHF-related care were estimated to be $28,756 for conventional therapy, and $36,420 and $38,867 for carvedilol (limited and extended benefits, respectively). Cost per life-year saved for carvedilol was $29,477 and $12,799 under limited and extended benefits assumptions, respectively. The cost effectiveness of carvedilol for CHF compares favorably to that of other generally accepted medical interventions, even under conservative assumptions regarding the duration of therapeutic benefit.
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        • Packer M
        Effects of beta-adrenergic blockade on survival of patients with chronic heart failure.
        Am J Cardiol. 1997; 80: 46L-54L
        • Heidenreich P.A
        • Lee T.T
        • Massie B.M
        Effects of beta blockade on mortality in patients with heart failure.
        J Am Coll Cardiol. 1997; 30: 27-34
        • Hjalmarson A
        • Kneider M
        • Waagstein F
        The role of beta-blockers in left ventricular dysfunction and heart failure.
        Drugs. 1997; 54: 501-510
        • Doughty R.N
        • Rodgers A
        • Sharpe N
        • MacMahon S
        Effects of beta-blocker therapy on mortality in patients with heart failure. A systematic overview of randomized controlled trials.
        Eur Heart J. 1997; 18: 560-565
        • Fowler M.B
        Effects of beta blockers on symptoms and functional capacity in heart failure.
        Am J Cardiol. 1997; 80: 55L-58L
      1. COREG (Carvedilol) Product Information. SmithKline Beecham Pharmaceuticals, Collegeville, PA, 1997.

        • Sonnenberg F.A
        • Beck J.R
        Markov models in medical decision making.
        Med Decis Making. 1993; 13: 322-358
        • Packer M
        • Bristol M.R
        • Cohn J.N
        • Colucci W.S
        • Fowler M.B
        • Gilbert E.M
        • Shusterman N.H
        • US Carvedilol Heart Failure Study Group
        The effect of carvedilol on morbidity and mortality in patients with chronic heart failure.
        N Engl J Med. 1996; 334: 1349-1355
      2. Bureau of Labor Statistics. Consumer Price Index. Washington D.C: U.S. Department of Labor, 1997.

        • Gold M.R
        • Siegel J.E
        • Russell L.B
        • Weinstein M.C
        Cost-Effectiveness in Health and Medicine. Oxford University Press, New York1996
        • Paul S.D
        • Kuntz K.M
        • Eagle K.A
        • Weinstein M.C
        Costs and effectiveness of angiotensin converting enzyme inhibition in patients with congestive heart failure.
        Arch Intern Med. 1994; 154: 1143-1149
        • Wolinsky F.D
        • Smith D.M
        • Stump T.E
        • Overhage J.M
        • Lubitz R.M
        The sequelae of hospitalization for congestive heart failure among older adults.
        J Am Geriatr Soc. 1997; 45: 558-563
        • The SOLVD Investigators
        Effect of enalapril in patients with reduced left ventricular ejection fractions and congestive heart failure.
        N Engl J Med. 1991; 325: 293-302
      3. 1997 Drug Topics Red Book. Montvale, NJ: Medical Economics Company Inc., 1997.

      4. Pharmacy Benefits Management Institute, Inc. 1996 Prescription Drug Benefit Cost and Plan Design Survey Report. Albuquerque, NM: Wellman Publishing Inc., 1997.

        • Glick H
        • Cook J
        • Kinosian B
        • Pitt B
        • Bourassa M.G
        • Pouleur H
        • Gerth Was
        Costs and effects of enalapril therapy in patients with symptomatic heart failure.
        J Cardiac Failure. 1995; 1: 371-380
        • Schulman K.A
        • Buxton M
        • Glick H
        • Sculpher M
        • Guzman G
        • Kong J
        • Backhouse M
        • Mauskopf J
        • Bell L
        • Eisenberg J
        Results of the economic evaluation of the FIRST study.
        Int J Technol Assess Health Care. 1996; 4: 698-713
      5. American Medical Association. Medicare RBRVS: The Physician’s Guide. Chicago (IL): American Medical Association, 1997.

      6. Agency for Health Care Policy and Research. The HCUP-3 National Inpatient Sample (NIS) Release-1, 1993, CD-ROM. Springfield, VA: National Technical Information Service, 1996.

      7. Health Care Financing Administration. Hospital Cost Report Information Service (HCRIS) Minimum Dataset, Public Use File. Baltimore, MD: Health Care Financing Administration, 1995.

        • Hodgson T.A
        • Kopstein A.N
        Health expenditures for major diseases in 1980.
        Health Care Fin Rev. 1984; 5: 1-12
        • Johannesson M
        • Jönsson B
        • Kjekshus J
        • Olsson A.G
        • Pedersen T.R
        • Wedel H
        • Scandinavian Simvastatin Survival Study Group
        Cost effectiveness of simvastatin treatment to lower cholesterol levels in patients with coronary heart disease.
        N Engl J Med. 1997; 336: 332-336
        • Mark D.B
        • Hlatky M.A
        • Califf R.M
        • Naylor C.D
        • Lee K.L
        • Armstrong P.W
        • Barbash G
        • White H
        Cost effectiveness of thrombolytic therapy with tissue plasminogen activator as compared with streptokinase for acute myocardial infarction.
        N Engl J Med. 1995; 332: 1418-1424
        • Goldman L
        • Benjamin Sia S.T
        • Cook E.F
        • Rutherford J.D
        • Weinstein M.C
        Costs and effectiveness of routine therapy with beta-adrenergic antagonists after routine myocardial infarction.
        N Engl J Med. 1988; 319: 152-157
        • Australia/New Zealand Heart Failure Research Collaborative Group
        Randomised placebo-controlled trial of carvedilol in patients with congestive heart failure due to ischaemic heart disease.
        Lancet. 1997; 349: 375-380
        • Pfeffer M.A
        • Stevenson L.W
        Beta-adrenergic blockers and survival in heart failure (editorial).
        N Engl J Med. 1996; 334: 1396-1397