title: Resource utilization and costs in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme.
abstract: OBJECTIVE
  More treatments are needed to improve clinical outcomes in chronic heart failure (HF). It is, however, important that treatments for a condition as common as HF are affordable. We have carried out a prospective economic analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme.
  
  
  RESULTS
  Patients with NYHA class II-IV HF and LVEF < or =0.40 were randomized to CHARM-Alternative if intolerant of an ACE-inhibitor or to CHARM-Added if taking an ACE-inhibitor. Patients with a LVEF >0.40 were randomized in CHARM-Preserved. Each trial compared the effect of candesartan to placebo on the primary outcome of cardiovascular death or HF hospitalization. Detailed information was prospectively collected on hospital admissions, procedures/operations and drugs. A cost-consequence analysis was performed for France, Germany and the UK for CHARM-Overall and a cost-effectiveness analysis for the low LVEF trials. The cost of candesartan was substantially offset by a reduction in hospital admissions, especially for HF. In the cost-consequence analysis, candesartan was cost-saving in most scenarios for CHARM-Alternative and Added but the marginal annual net cost per patient was upto 372 euros per year in CHARM-Preserved, in which candesartan did not reduce the primary outcome significantly. In the cost-effectiveness analysis of patients with a LVEF < or = 0.40, candesartan was cost-saving in some scenarios and in the others the maximum cost per life year gained was 3881 euros.
  
  
  CONCLUSIONS
  Candesartan improves functional class, reduces the risk of hospital admission, and increases survival in patients with a HF and a LVEF < or =0.40 at an acceptable cost.
authors.affiliation: Department of Cardiology, Level 4, Western Infirmary, Glasgow, Scotland, UK. j.mcmurray@bio.gla.ac.uk
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Fredrik L
authors.initials: FL
authors.lastname: Andersson
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
authors.forename: Klas
authors.initials: K
authors.lastname: Svensson
authors.forename: Alain Cohen
authors.initials: AC
authors.lastname: Solal
authors.forename: Rainer
authors.initials: R
authors.lastname: Dietz
authors.forename: Johan
authors.initials: J
authors.lastname: Vanhaecke
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Jan
authors.initials: J
authors.lastname: Ostergren
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000191:economics* / Q000627:therapeutic use; D001562:Benzimidazoles / Q000191:economics* / Q000627:therapeutic use; D001713:Biphenyl Compounds; D002304:Cardiac Pacing, Artificial / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D017721:Hospital Costs; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D012307:Risk Factors; D016019:Survival Analysis; D013777:Tetrazoles / Q000191:economics* / Q000627:therapeutic use; D019616:Thoracic Surgical Procedures / Q000706:statistics & numerical data
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan