14 November 2018
November 2018 post
Among cardiovascular diseases, heart failure (HF) is often referred to as a ‘final-stage’ condition. The prognosis is poor, with a mortality rate of approximately 50% within the first 5 years following diagnosis [Liao L et al. Economic burden of heart failure in the elderly. Pharmacoeconomics. 2008;26:447–62].
Patients with advanced HF (AdHF) are a relatively small but important contingent of the wider HF population who face substantial morbidity through continued deterioration of symptoms, and frequent hospitalization. AdHF places a considerable economic burden on hospital budgets, and therapies aimed at reducing the re-hospitalization rate have the potential to be of great economic value.
A useful contribution on this theme appeared earlier this year in the form of an abstract presented at the 2018 World Congress on Acute Heart Failure [Eur J Heart Fail. 2018;20 (Suppl. S1):398]. Prepared by Dr Josep Comin-Colet of the Bellvitge Hospital, Barcelona, Spain and fellow LION-HEART investigators, plus Spanish experts in health economics and outcomes research, this work reported on the net cost of intermittent intravenous levosimendan, given as an outpatient treatment to patients with AdHF.
Levosimendan therapy in the LION-HEART RCT reduced the rate of hospitalization for HF from the 66.7% seen in the control group to 22.9%. Hospitalizations for worsening HF are expensive: averting them saves money as well as improving patients’ quality of life. In the case of the Spanish centres enrolled in LION-HEART, the per-patient saving realized by using intermittent levosimendan was €2978.16. By including costs of the medications and other costs, therefore, use of intermittent levosimendan saved over €1000 per patient, net. A probabilistic analysis suggested a 94% chance of a saving.
The lesson from this research—and it’s not the first time such a lesson has emerged from pharmaco-economic analyses of levosimendan—is that the price of the drug is only part of the cost of treatment and that interventions that avert HF-related hospitalizations can in fact be much more affordable than a narrow focus on the unit price might suggest. Such outcomes are also of significant benefit to many patients and we should never lose sight of that.