The pharmacoeconomics of peri-operative beta-blocker therapy.
It is widely recommended that beta-blockade be used peri-operatively as it may reduce the incidence of postoperative cardiovascular complications including death. However, there are few data concerning the cost-effectiveness of such strategies. We have analysed the pharmacoeconomics of acute beta-blockade using data from eight prospective peri-operative studies in which patients underwent elective non-cardiac surgery, and in which the incidence of adverse side-effects of treatment, as well as clinical outcomes, have been reported. The costs of treatment were based on the NHS reference costs for 2004. From these data, the number-needed-to-treat (NNT) to prevent a major cardiovascular complication (including cardiovascular death) in high-risk patients was 18.5. This is comparable to the NNT for peri-operative statin therapy. The incremental cost of peri-operative beta-blockade (costs of drug acquisition and of treating associated adverse drug events) was 67.80 pounds sterling per patient. This results in a total cost of 1254.30 pounds sterling per peri-operative cardiovascular complication prevented. However, there is evidence that in patients at lower cardiovascular risk, beta-blockers may be potentially harmful, since their adverse effects (hypotension, bradycardia) may outweigh their potential cardioprotective effects.
Biccard
B M
BM
Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK. bruce.biccard@nda.ox.ac.uk
Sear
J W
JW
Foëx
P
P
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D019990:Perioperative Care / Q000191:economics* / Q000379:methods; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control; D011446:Prospective Studies; D006113:United Kingdom
D000319:Adrenergic beta-Antagonists