A UCLA study shows that heart-failure medications recommended by national guidelines are highly cost effective in saving lives and may also provide savings to the healthcare system. This study is one of the first to analyze the incremental cost-effectiveness of heart-failure medications and taking into account the latest information, including the lower costs of generic medications. Researchers found that the combination of these medical therapies demonstrated the greatest gains in quality-adjusted life years for heart-failure patients.
"We found that the 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 Gregg Fonarow, MD '87 (RES '93), the Eliot Corday Professor of Cardiovascular Medicine and Science and director of the Ahmanson-UCLA Cardiomyopathy Center.
The study focused on patients with mild-to-moderate chronic heart failure who had weakening function in the left ventricle. With the heart's diminishing function, fluid can build up in the lungs, so most patients take a diuretic. The research team used an advanced statistical model to assess the specific incremental and cumulative health- and cost-benefit contributions of three medications, compared with diuretics alone, in the treatment of heart-failure patients. The medications studied included angiotensin-converting enzyme inhibitors, aldosterone antagonists and beta blockers.
Researchers found that treatment with one or a combination of these medications was associated with lower costs and higher quality of life when compared to treatment with a diuretic alone. The greatest gain was achieved when all three guideline-directed medications were provided. The team found that the incremental cost-effectiveness ratio of adding each medication was less than $1,500 per each quality-adjusted life year for patients. In some scenarios, the medications were actually cost-saving, where heart-failure patients' lives were prolonged at lower costs to the healthcare system.
For the study, cost-effective interventions were defined as those providing good value with a cost of less than $50,000 per quality-adjusted life year, which is the general standard, Dr. Fonarow says. Cost-saving interventions are those that not only extend life but also save money for the healthcare system. Such interventions are not only more effective but are less costly. Dr. Fonarow noted that the costs of not effectively taking these key medications would be higher, due to increased hospitalizations and the need for other interventions.
"Incremental Cost-Effectiveness of Guideline-Directed Medical Therapies for Heart Failure," Journal of the American College of Cardiology, April 2, 2013