Cost effectiveness of carvedilol for heart failure

In this study, we examine the cost effectiveness of carvedilol for the trea tment of chronic heart failure (CHF). We use a Markov model to project life expectancy and lifetime medical care costs for a hypothetical cohort of pa tients with CHF who were assumed alternatively to receive carvedilol plus c onventional therapy (digoxin, diuretics, and angiotensin-converting enzyme inhibitors) or conventional therapy alone. Patients on carvedilol were assu med to experience a reduced risk of death and hospitalization for CHF, whic h is consistent with findings from the US Carvedilol Heart Failure Trials P rogram. The benefits of carvedilol were projected under 2 alternative scena rios. In the first ("limited benefits"), benefits were conservatively assum ed to persist for 6 months, the average duration of follow-up in these clin ical trials, and then end abruptly. In the other ("extended benefits"), the y were arbitrarily assumed to persist for 6 months and then decline gradual ly over time, vanishing by the end of 3 years. We estimated our model using data from the US Carvedilol Heart Failure Trials Program and other sources . For patients receiving conventional therapy alone, estimated life expecta ncy was 6.67 years; corresponding figures for those also receiving carvedil ol were 6.98 and 7.62 years under the limited and extended benefits scenari os, respectively. Expected lifetime costs of CHF-related care were estimate d to be $28,756 for conventional therapy, and $36,420 and $38,867 for carve dilol (limited and extended benefits, respectively). Cost per life-year sav ed for carvedilol was $29,477 and $12,799 under limited and extended benefi ts assumptions, respectively. The cost effectiveness of carvedilol for CHF compares favorably to that of other generally accepted medical intervention s, even. under conservative assumptions regarding the duration of therapeut ic benefit. (C) 1999 by Excerpta Medico, Inc.