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Recommended Heart Failure Meds Save Lives, and Maybe Money



Medical researchers at University of California in Los Angeles found medications recommended in national guidelines for heart failure are cost-effective in saving patient lives and could also provide financial savings for the national health care system. The findings of the team led by Gregg Fonarow, director of the cardiomyopathy center at UCLA, appear in the 2 April issue of the Journal of the American College of Cardiology (paid subscription required).

Fonarow’s team used a computer model to calculate the incremental cost effectiveness of three types of medications for heart failure recommended in national guidelines developed by the American College of Cardiology and the American Heart Association:

Angiotensin-converting enzyme (ACE) inhibitors, which relax blood vessels by preventing an enzyme that produces angiotensin II, a substance causing blood vessels to narrow and raise blood pressure

Beta-blockers, which target beta receptors found on cells of the heart muscles that respond to hormones like epinephrine or adrenaline, and cause the heart to beat more slowly and with less force

Aldosterone antagonists, which block receptors in the body for the hormone aldosterone, causing the kidneys to get rid of more fluid by increasing urine output, resulting in lower blood pressure, less total blood volume, and lower workload on the heart.

Fonarow and colleagues drew data from representative studies of patients with mild to moderate chronic heart-failure, as well as data from previous clinical trials and government statistics. The patients had weakened left ventricles in their hearts and symptoms of heart failure that can occur when the ventricle can no longer pump enough blood to the body’s other organs. In this condition, fluid can build up in the lungs, so most patients take a diuretic.

The researchers used a mathematical model, called a Markov model that estimates probability distributions, to calculate the incremental and cumulative contributions of the three medications, in terms of health and cost benefits compared to diuretics alone. Cost computations included medications (including generics), as well as inpatient and outpatient care. Benefits were calculated with an industry-standard measure of quality-adjusted life years.

Fonarow and colleagues found that patients receiving one or a combination of these medications also have with lower financial costs and a higher quality of life than patients receiving a diuretic alone. The team found patients taking all three guideline-directed medications are also those with the greatest gains in quality-adjusted life years. (The calculations show associations of events, and not necessarily causes and effects.)

“We found that use of one or more of these key medications in combination was associated with significant health gains while at the same time being cost-effective or providing a cost savings,” says Fonarow. Those savings were calculated from different treatment scenarios with cost-effective interventions defined as providing good value with a cost of less than $50,000 per quality-adjusted life year, a general standard in health care.

The researchers found the incremental cost-effectiveness ratio of adding each medication was less than $1,500 for each additional quality-adjusted life year for patients. In some cases, the medications resulted in cost savings, when patients’ lives were extended at lower costs to the health care system.

“Given the high health care value provided by these medical therapies for heart failure, reducing patient costs for these medications or even providing a financial incentive to promote adherence is likely to be advantageous to patients as well as the health care system,” notes Fonarow. “Further resources should be allocated to ensure full adherence to guideline-directed medical therapies for heart failure patients to improve outcomes, provide high-value care, and minimize health care costs.”

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