A cost-effectiveness analysis of bisoprolol for heart failure

Aims: This study considers the cost-effectiveness of bisoprolol in heart fa ilure patients as an adjunctive therapy to usual treatment. Methods and Res ults: A cost-effectiveness model was constructed using data available from the CIBIS I & II trials and other secondary sources. Differences in patient survival rates were calculated for bisoprolol (n = 1327) and placebo group s (n = 1320) extrapolating data over a 5-year period, under limited and ext ended benefits scenarios to calculate life years gained (LYG). Hospitalisat ion rates were calculated using data from both CIBIS trials. Costs were con sidered under two different patient management protocols for treatment init iation - shared care by outpatient clinics and GPs and initiation by a nurs e working in the community. Discounted LYG were calculated to be 0.228 unde r the limited benefits scenario and 0.368 under the extended benefits scena rio. Under the extended benefits scenario shared care resulted in a cost of pound 268 per LYG or pound 412 per LYG for community initiation. Under the limited benefits scenario the costs were a pound 135 saving and pound 69, respectively. Conclusion: This analysis has shown bisoprolol to be an econo mically attractive therapy in comparison with other treatments. It is hoped that its adoption by clinicians will be rapid, despite the labour intensiv e and time consuming up-titration process involved in its initiation. (C) 2 001 European Society of Cardiology. All rights reserved.