Intravenous levosimendan treatment is cost-effective compared with dobutamine in severe low-output heart failure: an analysis based on the international LIDO trial.
BACKGROUND
Levosimendan, a novel calcium sensitiser, improves cardiac performance and symptoms without increasing oxygen consumption, and decreases the mortality of patients with low-output heart failure.


OBJECTIVE
To estimate the cost-effectiveness of intravenous treatment with levosimendan compared with dobutamine in patients with severe low-output heart failure.


METHODS
This economic evaluation was based on a European clinical trial (LIDO), in which 203 patients with severe heart failure randomly received a 24 h infusion with either levosimendan or dobutamine. Survival and resource utilisation data were collected for 6 months; survival was extrapolated assuming a mean additional lifetime of 3 years based on data from the Cooperative North Scandinavian Enalapril Survival Study trial. Costs were based on study drug usage and hospitalisation in the 6-month follow-up. A sensitivity analysis on dosage of drug and duration of survival was performed.


RESULTS
The mean survival over 6 months was 157+/-52 days in the levosimendan group and 139+/-64 days in the dobutamine group (P<0.01). When extrapolated up to 3 years, the gain in life expectancy was estimated at 0.35 years (discounted at 3%). Levosimendan increased the mean cost per patient by 1108, which was entirely due to the cost of the study drug. The incremental cost per life-year saved (LYS) was 3205 at the European level; in the individual countries the cost per LYS ranged between 3091 and 3331. The result was robust in the sensitivity analysis.


CONCLUSIONS
Although the patients in the levosimendan group were alive for more days and thus at risk of hospitalisation for longer, there was no increase in hospitalisation or hospitalisation costs with levosimendan treatment. The cost per LYS using levosimendan compares favourably with other cost-effectiveness analyses in cardiology.
Cleland
J G F
JG
Department of Cardiology, Castle Hill Hospital, Castle Road, Cottingham, University of Hull, Kingston upon Hull HU16 5JQ, UK. j.g.cleland@hull.ac.uk
Takala
A
A
Apajasalo
M
M
Zethraeus
N
N
Kobelt
G
G
D000368:Aged; D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D002316:Cardiotonic Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis / Q000191:economics; D004280:Dobutamine / Q000191:economics* / Q000627:therapeutic use*; D004311:Double-Blind Method; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D006835:Hydrazones / Q000191:economics* / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000191:economics; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics; D011724:Pyridazines / Q000191:economics* / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D000077464:Simendan; D016019:Survival Analysis; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D004280:Dobutamine