title: What is the economic value of digoxin therapy in congestive heart failure patients? Results from the DIG trial.
abstract: BACKGROUND
  The Digitalis Investigation Group (DIG) clinical train randomized 6800 congestive heart failure patients (ejection fraction > or =45%) to a daily regimen of either digoxin or placebo. At 37 months average follow-up, patients in both groups had similar mortality. We determined the incremental costs associated with the use of digoxin in this high-risk population.
  
  
  RESULTS
  Hospitalizations and medical costs were compared by using a societal perspective. Hospitalizations were assigned Medicare DRG codes by using descriptive information from the clinical trial. Digoxin use was assigned a cost by using the 1998 average wholesale price as reported by Red Book. On average, there were fewer hospitalizations in digoxin-treated patients. These patients had lower heart failure yet higher non-heart failure hospitalization costs than placebo patients. Digoxin therapy was cost saving versus placebo in only 27% of 1000 bootstrap samples using Medicare costs (mean costs 12,648 dollars vs. 12,362 dollars) and in 44% of samples using commercial carrier costs (mean costs 17,400 dollars vs. 17,306 dollars). How ever, digoxin was cost saving in >50% of samples for several higher-risk patient subgroups.
  
  
  CONCLUSIONS
  The use of digoxin therapy versus placebo was associated with reduced hospitalizations. Moreover, the resulting cost-savings could cover the costs of this inexpensive therapy in selected subgroups of higher-risk patients. In the remainder, there is a modest cost associated with this therapy.
authors.affiliation: The Outcomes Research and Assessment Group, The Duke Clinical Research Institute, Durham, North Carolina 27715, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Eisenstein
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.forename: Vishal
authors.initials: V
authors.lastname: Bindal
authors.forename: Martial G
authors.initials: MG
authors.lastname: Bourassa
authors.forename: Anne
authors.initials: A
authors.lastname: Horney
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Collins
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Mark
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003363:Cost Control; D004077:Digoxin / Q000627:therapeutic use*; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D006333:Heart Failure / Q000188:drug therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare; D016032:Randomized Controlled Trials as Topic
chemical_list: D002316:Cardiotonic Agents; D004077:Digoxin