ECONOMIC OUTCOMES OF WITHDRAWAL OF DIGOXIN THERAPY IN ADULT PATIENTS WITH STABLE CONGESTIVE-HEART-FAILURE

Objectives. This study sought to analyze the health and economic outco mes of withdrawal of digoxin therapy among U.S. adult patients with st able congestive heart failure. Background. New information regarding t he outcomes of digoxin withdrawal has been provided by the Prospective Randomized Study of Ventricular Failure and Efficacy of Digoxin (PROV ED) and Randomized Assessment of Digoxin and Inhibitors of Angiotensin -Converting Enzyme (RADIANCE) trials. We interpreted and extrapolated the results of these trials to describe implications on a national lev el. Methods. We used a decision-analytic model to estimate the outcome s of two alternative strategies to 1) continue and 2) withdraw digoxin in patients with congestive heart failure with normal sinus rhythm, N ew York Heart Association functional class II or III and left ventricu lar ejection fraction less than or equal to 35%. Epidemiologic assumpt ions were derived from published reports and expert opinion. Assumptio ns regarding the effectiveness of digoxin therapy were derived from th e RADIANCE and PROVED digoxin withdrawal trials, Hospital and Medicare data were used for economic assumptions. Calculated outcomes included treatment failures, cases of digoxin toxicity and health care costs. Results. The continuation of digoxin therapy in these patients with co ngestive heart failure nationally would avoid an estimated 185,000 cli nic visits, 27,000 emergency visits and 137,000 hospital admissions fo r congestive heart failure. After accounting for an estimated 12,500 c ases of digoxin toxicity, the net annual savings would be $406 million , with a 90% range of uncertainty of $106 to $822 million. One-way sen sitivity analysis indicated that digoxin therapy is cost-saving when t he assumed annual incidence of digoxin toxicity is less than or equal to 33%. Conclusions. The continuation of digoxin therapy in patients w ith stable congestive heart failure should be strongly considered, bec ause this strategy is likely to lead to both lower costs and greater h ealth benefits on the basis of available information.