[Cost effectiveness of ACE inhibition in therapy of chronic heart failure in Switzerland: evaluation based on the SOLVD study].
OBJECTIVE
Morbidity and mortality data in Switzerland underline the socioeconomic importance of heart failure. In the SOLVD study (Study on Left Ventricular Dysfunction), cardiovascular morbidity and mortality were reduced with the ACE inhibitor enalapril in patients with heart failure. The economic implications of this treatment were analyzed in a retrospective economic analysis from the perspective of Swiss third party payers.


METHODS
Source of the economic analysis was the SOLVD study data. This prospective study was placebo-controlled, double-blind and had a mean follow-up of 3.45 years (41.4 months), involving 2569 patients with heart failure, mainly in NYHA classes II and III. Costing data for treatment with enalapril, the per diem charges for hospitalization and the average length of hospital stay were retrieved from published national sources. The costs of in- and output were calculated and compared for the two treatment groups in a cost-efficacy analysis.


RESULTS
Additional treatment with enalapril resulted in an additional cost of 2.5 million Swiss francs. These incremental costs were, however, offset by reduced hospital costs (CHF 6.45 million savings) in the enalapril group. For the complete treatment cohort of the SOLVD study, the net savings were approximately 4.26 million Swiss francs.


CONCLUSIONS
From the clinical point of view, treatment with ACE inhibitors leads to a reduction in the progression of heart failure and reduced cardiovascular morbidity and mortality. With respect to health economics, it can be demonstrated that treatment with enalapril does not only offer clinical benefits, but that these also translate into impressive economic savings of CHF 3315 per patient.
Szucs
T D
TD
Forschungsgruppe Medizinische Okonomie, München.
Goedde
M
M
Berger
K
K
Kiowski
W
W
D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D004656:Enalapril / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics*; D011446:Prospective Studies; D013557:Switzerland / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000191:economics* / Q000401:mortality
D000806:Angiotensin-Converting Enzyme Inhibitors; D004656:Enalapril