[Congestive heart failure in Spain: cost-effectiveness and cost-benefit analyses of treatment with beta-blockers].
OBJECTIVE
Beta-blockers (BB) have proven to be effective in the treatment of congestive heart failure (CHF). This study is an economic analysis for the addition of BB to standard treatment of CHF.


METHODS
Randomized, double-blinded controlled studies are included, with 1,647 patients treated with bisoprolol, 3,034 treated with carvedilol, 2,432 treated with metoprolol, and 6,807 treated with placebo. Direct costs of BB treatment and of every hospitalization episode are assessed. Cost-effectiveness is assessed as cost in euros by prevented death, and cost-benefit as the difference between hospitalization costs and BB costs. The study is conducted from the perspective of a third-party payer.


RESULTS
Two studies with bisoprolol, six with carvedilol, and five with metoprolol are included, with an average follow-up of 13.5 months. Carvedilol prevents 5.07% of deaths per year of treatment and is more effective than bisoprolol (3.82% of avoided deaths) and metoprolol (3.03%). Cost-effectiveness ratio (cost for every prevented death and year) was 10,832 euros for bisoprolol, 17,516 euros for carvedilol and 16,664 euros for metoprolol. Incremental cost-effectiveness ratio for carvedilol ranges between 12,631 euros and 86,610 euros for life saved. All BB generate costs saving for hospitalization but only bisoprolol provides a net profit. Benefit-cost index is 1.13 for bisoprolol, 0.26 for carvedilol and 0.59 for metoprolol.


CONCLUSIONS
Use of BB in the treatment of CHF is an effective and cost-effective alternative. Carvedilol is the most effective alternative, and bisoprolol the most cost-effective alternative and the drug with greater benefit-cost index.
Díez Manglano
J
J
Hospital Royo Villanova, Zaragoza. jdiez@aragob.es
D000319:Adrenergic beta-Antagonists / Q000191:economics* / Q000627:therapeutic use*; D017298:Bisoprolol / Q000191:economics / Q000627:therapeutic use; D002227:Carbazoles / Q000191:economics / Q000627:therapeutic use; D000077261:Carvedilol; D003362:Cost-Benefit Analysis; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D008790:Metoprolol / Q000191:economics / Q000627:therapeutic use; D011412:Propanolamines / Q000191:economics / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013030:Spain
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol; D017298:Bisoprolol