Health gains, cost savings seen with heart failure drugs

Guideline-directed medical therapy for heart failure (HF) is highly cost-effective and able to produce significant health gains for individuals with mild to moderate disease, according a study published April 2 in the Journal of the American College of Cardiology.

With the introduction of generic formulations of angiotensin-converting enzyme inhibitors (ACEI), beta-blockers (BB), and aldosterone antagonists (AldA), California researchers wanted to quantify the incremental cost-savings of these therapies, compared to diuretic therapy in patients with mild to moderate HF.

The study compared the baseline cohort of patient receiving only diuretics to three treatment groups of patients who received ACEI, ACEI and BB, and ACEI plus BB plus AldA. The researchers also compared each incremental therapy to the previous therapy.

Patients who received ACEI, BB, and AldA had the highest health gains in terms of both total life-years and quality of life years (QALYs) compared with the other three treatment groups. These patients had 5.01 total life-years and 3.90 QALYs. In the group treated with ACEI and BB, total life-years were 4.91 and 3.83 QALYs. In the ACEI-treated group, total life-years were 4.60 and 3.59 QALYs. The baseline diuretic-treated group had 4.45 total life-years and 3.47 QALYs.

In terms of cost, the diuretic-alone cohort had $12,742 in healthcare costs. For patients in the ACEI cohort, the savings amounted to $444 compared to the diuretic-only group. For patients in the ACEI and BB cohort, the savings were $33 compared to the baseline group. The patients treated with ACEI, BB, and AldA had higher costs ($47) compared with the diuretic-only cohort. The researchers found no real incremental cost-savings when comparing the ACEI and BB group to the ACEI group or comparing the ACEI, BB, and AldA group with the ACEI and BB group.

The hospital rates declined over the first 5 years with generic guideline-directed medication therapy. In the diuretic-only group, HF hospitalizations per 100 people were 110. In the ACEI cohort, HF hospitalizations per 100 were 97. In the ACEI and BB group, they were 88. In the ACEI, BB, and AldA group, they were only 82.

“The direct costs of medical treatment of HF have been significantly reduced since ACEI, BB, and AldA all have generic versions; this in itself may increase adherence,” the authors wrote.

“Given the very high healthcare value provided by guideline-directed medical therapies for HFrEF (heart failure with reduced ejection fraction), eliminating all patient costs for these medications or even providing financial incentives to promote adherence is likely to be advantageous to patients, healthcare delivery systems, and society, although these benefits may not be equally shared,” they wrote.

More resources are needed to help patients with heart failure adhere to their medication regimens, they concluded.