Pharmacoeconomics in heart failure: impact of drug and non-drug based treatment

Heart failure is a common and increasing problem associated with a high mor bidity and mortality. The high morbidity of heart failure imposes the major ity of costs of its treatment. Hospitalization among patients with heart fa ilure is frequent, increasing, recurrent and often prolonged and constitute s about 65% of health spending on heart failure. A number of strategies can be envisaged to reduce recurrent heart failure hospitalization. ACE inhibi tors (especially high-dose), beta-blockers, spironolactone and possibly dig oxin, have all been shown to reduce substantially all-cause hospitalization in patients with heart failure in double-blind controlled trials. The most common single reason for re-admission is for worsening heart failure which may frequently be exacerbated by incomplete and unpredictable absorption o f some diuretics. The loop diuretic, torasemide, because of its favourable pharmacokinetic and pharmacodynamic profile may be able to prevent worsenin g of underlying heart failure developing into a crisis, leading to hospital ization. Studies confirm that treatment with torasemide can reduce the rate of hospitalization due to worsening heart failure and is cost-effective. A stumbling block to progress that is often encountered is the unwillingness of budget holders to spend a small amount of money on better drugs and out patient services in order to prevent hospitalization. This is exacerbated i n many countries by a separate system for care of patients in and out of ho spital. (Eur Heart J Supplements 2001; 3 (Suppl G): G25-G32) (C) 2001 The E uropean Society of Cardiology.