[Economic evaluation of treatments of cardiac insufficiency].
The objective of classical treatments of cardiac failure (diuretics, digitalis) was to relieve patients' symptoms. Vasodilators and ACE inhibitors also improve morbidity and mortality. The introduction of the latter class of drugs for cardiac failure will, however, lead to a significant increase in the cost of medication at national level. These costs may increase even further in theory due to a predictable increase in the number of patients with cardiac failure (ageing of the general population, improved survival of cardiac patients) and due to the extension of prescription of these drugs to populations of subjects with cardiac failure hitherto relatively undertreated. On the other hand, economies may be realised in the management of cardiac failure related to fewer and shorter hospital admissions and reduced indirect costs or to the suppression of previous, less useful drugs (calcium antagonists, digitalis). Cost-effective analyses with ACE inhibitors carried out in different countries (Canada, netherlands) tend to show that the costs induced by prescription of these drugs are more than compensated by the economies realised by the reduction in hospital admissions. This is even more marked in the treatment of patients with severe cardiac failure. In subjects at low risk, the prescription of ACE inhibitors would not seem to be justified from both the clinical and economic points of view. It is up to each physician to decide the threshold of basic risk below which this treatment becomes "economically" acceptable.
Leizorovicz
A
A
Service de pharmacologie clinique, Hôpital cardiologique, Lyon.
Cucherat
M
M
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006801:Humans; D016019:Survival Analysis
D000806:Angiotensin-Converting Enzyme Inhibitors
Evaluation économique des traitements de l'insuffisance cardiaque.