Cost-effectiveness of beta-blocker therapy with metoprolol or with carvedilol for treatment of heart failure in Canada

Objective The purpose of this study was to estimate the cost-effectiveness of beta -blocker therapy with either metoprolol or carvedilol in addition t o conventional therapy for patients with heart failure (HF) in Canada. Design A Markov simulation was used to estimate the costs and life expectan cy for treating patients with conventional therapy alone and with the addit ion of metoprolol or carvedilol. Although carvedilol has been marketed in C anada since 1999, metoprolol succinate has yet to be marketed there, so the price is unknown. Therefore we inputed a Canadian price based on the price ratio of the 2 drugs in the United States. Results For subjects aged 60 years at HF onset, the expected years of life are 4.53 years for those treated with conventional therapy alone, 5.70 year s for those who receive conventional therapy plus metoprolol, and 6.21 year s for those who receive conventional therapy plus carvedilol. The expected costs (in 1999 Canadian dollars) are $8,989, $13,833, and $18,114, respecti vely. This yields incremental cost-effectiveness ratios (ICERs) for metopro lol relative to conventional therapy alone of $4,140 per life-year gained, and for carvedilol relative to metoprolol, the ICER is $8,394 per life-year gained. Conclusions In addition to conventional therapy with furosemide and angiote nsin converting enzyme inhibitors, treatment with either metoprolol or carv edilol confers a survival benefit that is attractive from a cost-effectiven ess point of view. Until better information becomes available, it is not po ssible to distinguish between the two beta -blockers on the basis of cost-e ffectiveness. This means that the choice of beta -blockers for HF should be based largely on clinical considerations because both beta -blockers prolo ng life at relatively low cost.