Health and economic benefits of increased beta-blocker use following myocardial infarction

Context beta -Blockers are underused in patients who have myocardial infarc tion (MI), despite the proven efficacy of these agents. New evidence indica tes that beta -blockers can have benefit in patients with conditions that h ave been considered relative contraindications, Understanding the consequen ces of underuse of beta -blockers is important because of the implications for current policy debates over quality-of-care measures and Medicare presc ription drug coverage, Objective To examine the potential health and economic impact of increased use of beta -blockers in patients who have had MI. Design and Setting We used the Coronary Heart Disease (CHD) Policy Model, a computer-simulation Markov model of CHD in the US population, to estimate the epidemiological impact and cost-effectiveness of increased beta -blocke r use from current to target levels among survivors of MI aged 35 to 84 yea rs. Simulations included 1 cohort of MI survivors in 2000 followed up for 2 0 years and 20 successive annual cohorts of all first-MI survivors in 2000- 2020. Mortality and morbidity from CHD were derived from published meta-ana lyses and recent studies. This analysis used a societal perspective. Main Outcome Measures Prevented Mis, CHD mortality, life-years gained, and cost per quality-adjusted life-year (QALY) gained in 2000-2020, Results Initiating beta -blocker use for all MI survivors except those with absolute contraindications in 2000 and continuing treatment for 20 years w ould result in 4300 fewer CHD deaths, 3500 Mis prevented, and 45000 life-ye ars gained compared with current use. The incremental cost per QALY gained would be $4500, If this increase in beta -blocker use were implemented in a ll first-MI survivors annually over 20 years, beta -blockers would save $18 million and result in 72000 fewer CHD deaths, 62000 Mis prevented, and 447 000 life-years gained. Sensitivity analyses demonstrated that the cost-effe ctiveness of beta -blocker therapy would always be less than $11000 per QAL Y gained, even under unfavorable assumptions, and may even be cost saving, Restricting beta -blockers only to ideal patients (those without absolute o r relative contraindications) would reduce the epidemiological impact of be ta -blocker therapy by about 60%, Conclusions Our simulation indicates that increased use of beta -blockers a fter MI would lead to impressive gains in health and would be potentially c ost saving.