Economic implications of extended-release metoprolol succinate for heart failure in the MERIT-HF trial: a US perspective of the MERIT-HF trial.
BACKGROUND
The MERIT-HF trial demonstrated improved survival and fewer hospitalizations for worsening heart failure with extended-release (ER) metoprolol succinate in patients with heart failure. This study sought to estimate the economic implications of this trial from a US perspective.


RESULTS
A discrete event simulation was developed to examine the course of patients with heart failure. Characteristics of the population modeled, probabilities of hospitalization and death with standard therapy, and risk reductions with ER metoprolol succinate were obtained from Metoprolol CR/XL Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF) and evaluated in weekly cycles. Direct medical costs were estimated from US databases in 2001 US dollars. Uncertainty in inputs was incorporated and analyses were carried out to estimate events prevented total and net costs. The model predicts that ER metoprolol succinate will prevent approximately 7 deaths and 15 hospitalizations from heart failure per 100 patients over 2 years. Compared with standard therapy alone, this translates to a cost reduction between $395 and $1112 per patient, depending on whether the costs of hospitalizations for other causes are included. Savings were maintained in 90% of the simulations.


CONCLUSIONS
This analysis predicts that the positive effect of ER metoprolol succinate on mortality and morbidity demonstrated in MERIT-HF leads to substantial savings.
Caro
J Jamie
JJ
Caro Research Institute, Concord, Massachusetts 01742, USA.
Migliaccio-Walle
Kristin
K
O'Brien
Judith A
JA
Nova
William
W
Kim
Jennifer
J
Hauch
Ole
O
Hillson
Eric
E
Wedel
Hans
H
Hjalmarson
Ake
A
Gottlieb
Stephen
S
Deedwania
Prakash C
PC
Wikstrand
John
J
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003692:Delayed-Action Preparations; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D017721:Hospital Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D008875:Middle Aged; D017059:Models, Econometric; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
D000319:Adrenergic beta-Antagonists; D003692:Delayed-Action Preparations; D008790:Metoprolol