Resource utilization and costs in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme.
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.
McMurray
John J V
JJ
Department of Cardiology, Level 4, Western Infirmary, Glasgow, Scotland, UK. j.mcmurray@bio.gla.ac.uk
Andersson
Fredrik L
FL
Stewart
Simon
S
Svensson
Klas
K
Solal
Alain Cohen
AC
Dietz
Rainer
R
Vanhaecke
Johan
J
van Veldhuisen
Dirk J
DJ
Ostergren
Jan
J
Granger
Christopher B
CB
Yusuf
Salim
S
Pfeffer
Marc A
MA
Swedberg
Karl
K
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
D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan