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Cost-effectiveness of fixed-dose combination of isosorbide dinitrate and hydralazine therapy for blacks with heart failure.
Circulation. 2005 Dec 13; 112(24):3745-53.Circ

Abstract

BACKGROUND

Fixed-dose combination of isosorbide dinitrate/hydralazine (ISDN/HYD) improved clinical outcomes in the African-American Heart Failure Trial (A-HeFT). We assessed the resource use, costs of care, and cost-effectiveness of ISDN/HYD therapy in the A-HeFT trial population.

METHODS AND RESULTS

We obtained resource use data from A-HeFT, assigning costs through the use of US federal sources. Excluding indirect costs, we summarized the within-trial experience and modeled cost-effectiveness over extended time horizons, including a US societal lifetime reference case. During the mean trial follow-up of 12.8 months, the ISDN/HYD group incurred fewer heart failure-related hospitalizations (0.33 versus 0.47 per subject; P=0.002) and shorter mean hospital stays (6.7 versus 7.9 days; P=0.006). When study drug costs were excluded, both heart failure-related and total healthcare costs were lower in the ISDN/HYD group (mean per-subject heart failure-related costs, 5997 dollars versus 9144 dollars; P=0.04; mean per-subject total healthcare costs, 15,384 dollars versus 19,728 dollars; P=0.03). With an average daily drug cost of 6.38 dollars, ISDN/HYD therapy was dominant (reduced costs and improved outcomes) over the trial duration. Assuming that no additional benefits accrue beyond the trial, we project the cost-effectiveness of ISDN/HYD therapy using heart failure-related costs to be 16,600 dollars/life-year at 2 years after enrollment, 37,100 dollars/life-year at 5 years, and 41,800 dollars/life-year over lifetime (reference case).

CONCLUSIONS

ISDN/HYD therapy, previously shown to improve clinical outcomes, also reduced resource use and costs in A-HeFT, primarily because of a large reduction in hospitalizations. Long-term use of ISDN/HYD therapy should be associated with a favorable cost-effectiveness profile in this population.

Authors+Show Affiliations

Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA. angusdc@upmc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16344404

Citation

Angus, Derek C., et al. "Cost-effectiveness of Fixed-dose Combination of Isosorbide Dinitrate and Hydralazine Therapy for Blacks With Heart Failure." Circulation, vol. 112, no. 24, 2005, pp. 3745-53.
Angus DC, Linde-Zwirble WT, Tam SW, et al. Cost-effectiveness of fixed-dose combination of isosorbide dinitrate and hydralazine therapy for blacks with heart failure. Circulation. 2005;112(24):3745-53.
Angus, D. C., Linde-Zwirble, W. T., Tam, S. W., Ghali, J. K., Sabolinski, M. L., Villagra, V. G., Winkelmayer, W. C., & Worcel, M. (2005). Cost-effectiveness of fixed-dose combination of isosorbide dinitrate and hydralazine therapy for blacks with heart failure. Circulation, 112(24), 3745-53.
Angus DC, et al. Cost-effectiveness of Fixed-dose Combination of Isosorbide Dinitrate and Hydralazine Therapy for Blacks With Heart Failure. Circulation. 2005 Dec 13;112(24):3745-53. PubMed PMID: 16344404.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of fixed-dose combination of isosorbide dinitrate and hydralazine therapy for blacks with heart failure. AU - Angus,Derek C, AU - Linde-Zwirble,Walter T, AU - Tam,S William, AU - Ghali,Jalal K, AU - Sabolinski,Michael L, AU - Villagra,Victor G, AU - Winkelmayer,Wolfgang C, AU - Worcel,Manuel, AU - ,, PY - 2005/12/14/pubmed PY - 2006/2/24/medline PY - 2005/12/14/entrez SP - 3745 EP - 53 JF - Circulation JO - Circulation VL - 112 IS - 24 N2 - BACKGROUND: Fixed-dose combination of isosorbide dinitrate/hydralazine (ISDN/HYD) improved clinical outcomes in the African-American Heart Failure Trial (A-HeFT). We assessed the resource use, costs of care, and cost-effectiveness of ISDN/HYD therapy in the A-HeFT trial population. METHODS AND RESULTS: We obtained resource use data from A-HeFT, assigning costs through the use of US federal sources. Excluding indirect costs, we summarized the within-trial experience and modeled cost-effectiveness over extended time horizons, including a US societal lifetime reference case. During the mean trial follow-up of 12.8 months, the ISDN/HYD group incurred fewer heart failure-related hospitalizations (0.33 versus 0.47 per subject; P=0.002) and shorter mean hospital stays (6.7 versus 7.9 days; P=0.006). When study drug costs were excluded, both heart failure-related and total healthcare costs were lower in the ISDN/HYD group (mean per-subject heart failure-related costs, 5997 dollars versus 9144 dollars; P=0.04; mean per-subject total healthcare costs, 15,384 dollars versus 19,728 dollars; P=0.03). With an average daily drug cost of 6.38 dollars, ISDN/HYD therapy was dominant (reduced costs and improved outcomes) over the trial duration. Assuming that no additional benefits accrue beyond the trial, we project the cost-effectiveness of ISDN/HYD therapy using heart failure-related costs to be 16,600 dollars/life-year at 2 years after enrollment, 37,100 dollars/life-year at 5 years, and 41,800 dollars/life-year over lifetime (reference case). CONCLUSIONS: ISDN/HYD therapy, previously shown to improve clinical outcomes, also reduced resource use and costs in A-HeFT, primarily because of a large reduction in hospitalizations. Long-term use of ISDN/HYD therapy should be associated with a favorable cost-effectiveness profile in this population. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/16344404/Cost_effectiveness_of_fixed_dose_combination_of_isosorbide_dinitrate_and_hydralazine_therapy_for_blacks_with_heart_failure_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.105.563882?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -