What is the economic value of digoxin therapy in congestive heart failure patients? Results from the DIG trial.
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.
Eisenstein
Eric L
EL
The Outcomes Research and Assessment Group, The Duke Clinical Research Institute, Durham, North Carolina 27715, USA.
Yusuf
Salim
S
Bindal
Vishal
V
Bourassa
Martial G
MG
Horney
Anne
A
Collins
Joseph F
JF
Mark
Daniel B
DB
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
D002316:Cardiotonic Agents; D004077:Digoxin