[Economic study of carvedilol in heart failure. A cost effectiveness study in France].
A programme of four phase III clinical trials carried out in the USA on 1094 patients showed that Carvedilol, associated with the usual bitherapy and eventually with digitalis, reduced the mortality and number of hospital admissions of patients with cardiac failure. These results, transposed to the French population, may be used to evaluate the economic advantages of Carvedilol by developing a cost-effectiveness study which consists in relating the direct expenses (drugs and hospital admissions) of each of the two strategies, with or without Carvedilol, to their respective mortalities. Hospital expenses were estimated with respect to the H.M.G. corresponding to each hospital stay at 1997-1998 values. The cost in the Carvedilol group was 2,823 FF per patient (including 1,491 FF for the drug itself) but 2,056 FF were economised in hospital expenses. With an increased cost of 767 FF but a 50% reduction in mortality corresponding to a difference in mortality of 45@1000, the cost-effectiveness of Carvedilol was 17,040 per life saved and 2,130 FF per additional year of life expectancy. A study of the sensitivity produced even more favourable results of Carvedilol. An evaluation of hospital expenses on the basis of AP-HP data indicates that the addition of Carvedilol is associated with a 4,425 FF reduction in hospital expenses, which makes it a cost saving strategy.
LEGOS, université Paris-IX Dauphine, place du Maréchal-de-Lattre-de-Tassigny, 75775 Paris.
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Lévy
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JL
Dubois-Randé
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Cohen-Solal
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Lévy
D000319:Adrenergic beta-Antagonists / Q000191:economics* / Q000627:therapeutic use*; D002227:Carbazoles / Q000191:economics* / Q000627:therapeutic use*; D000077261:Carvedilol; D003362:Cost-Benefit Analysis; D004070:Digitalis / Q000627:therapeutic use; D004469:Economics, Hospital; D005602:France; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008017:Life Expectancy; D008517:Phytotherapy; D010946:Plants, Medicinal; D010947:Plants, Toxic; D011412:Propanolamines / Q000191:economics* / Q000627:therapeutic use*; D013997:Time Factors
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol