title: Reimbursement claims analysis of outcomes with carvedilol and metoprolol.
abstract: OBJECTIVE
  To compare resource use and costs in heart failure (HF) patients receiving metoprolol, a selective beta1-receptor blocker, with carvedilol, which blocks beta1-, beta2-, and alpha1-adrenergic receptors, by use of a retrospective reimbursement-claims analysis.
  
  
  METHODS
  Resource use and cost data were extracted for patients diagnosed with HF and treated with carvedilol or metoprolol for 6 months after the initiation of the respective therapy, by use of claims submitted to 6 healthcare plans. A modified Charlson index was used to assess comorbidity. Stepwise logistic regression was used to measure the influence of treatment on hospitalization.
  
  
  RESULTS
  Claims from 139 carvedilol and 106 metoprolol patients showed that carvedilol patients experienced significantly fewer total hospitalizations (36.0% vs. 62.3%, respectively; p < 0.001) and emergency department visits (23.7% vs. 42.5%, respectively; p = 0.002) and a trend for fewer HF-related (7.9% vs. 14.2%, respectively; NS) and cardiac-related hospitalizations (15.1% vs. 24.5%, respectively; NS). Treatment with carvedilol was associated with a significant decrease in the risk of any hospitalization (adjusted odds ratio 0.35, 95% CI 0.20 to 0.63; p <0.001). Higher pharmacy costs (mean $1677 vs. $1322; p <0.001) and lower total costs (mean $8100 vs. $14475; p = 0.025) were observed in carvedilol-treated compared with metoprolol-treated patients, respectively.
  
  
  CONCLUSIONS
  Compared with metoprolol, the more comprehensive adrenergic blockade achieved with carvedilol may translate into greater clinical benefits in patients with HF. Despite higher pharmacy costs, lower total costs were observed in carvedilol-treated patients.
authors.affiliation: School of Pharmacy, University of Buffalo, NY 14260-1200, USA. luzier@acsu.buffalo.edu
authors.forename: Aileen B
authors.initials: AB
authors.lastname: Luzier
authors.forename: Laura A
authors.initials: LA
authors.lastname: Antell
authors.forename: Li-Ling
authors.initials: LL
authors.lastname: Chang
authors.forename: Jianwei
authors.initials: J
authors.lastname: Xuan
authors.forename: David A
authors.initials: DA
authors.lastname: Roth
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use*; D002227:Carbazoles / Q000191:economics / Q000627:therapeutic use*; D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000191:economics; D000077261:Carvedilol; D015897:Comorbidity; D005252:Fees, Pharmaceutical; D005260:Female; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D008790:Metoprolol / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D011412:Propanolamines / Q000191:economics / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol