title: Long-term cost-effectiveness analysis of nebivolol compared with standard care in elderly patients with heart failure: an individual patient-based simulation model.
abstract: OBJECTIVE
  The SENIORS trial demonstrated that nebivolol is effective in the treatment of heart failure in elderly patients (e.g. > or = 70 years). This analysis evaluates the cost effectiveness of nebivolol compared with standard treatment.
  
  
  METHODS
  An individual patient-simulation model based on a Markov modelling framework was developed to compare costs and outcomes for nebivolol and standard care in patients with heart failure starting treatment at the age of 70 years. Health states were defined by New York Heart Association (NYHA) class and death. At a given NYHA class and a given cycle, patients could die, be hospitalized for cardiovascular disease or remain stable. Risks for these events were derived from individual patient data from the SENIORS trial. The risk of each event in a given cycle was based on the subject's baseline characteristics and time in the current health state. The economic analysis was conducted from the UK NHS perspective with a lifetime horizon. The costs (euro; year 2006 values) considered were drug costs for nebivolol and other cardiac drugs, costs of GP visits, outpatient specialist visits and cardiovascular-related hospitalizations. Univariate and probabilistic sensitivity analysis was conducted.
  
  
  RESULTS
  In the baseline analysis, the total cost per patient was euro6740 and euro9288, and QALYs were 5.194 and 5.843 for patients aged 70 years at the start of treatment for the standard treatment and nebivolol groups, respectively. The probabilistic sensitivity analysis provided an incremental cost-effectiveness ratio of euro3926 (95% CI 3731, 4159) per QALY.
  
  
  CONCLUSIONS
  This analysis indicates that nebivolol appears to be a cost-effective treatment for elderly patients with heart failure compared with standard care.
authors.affiliation: University of Birmingham, Birmingham, UK.
authors.forename: Guiqing
authors.initials: G
authors.lastname: Yao
authors.forename: Nick
authors.initials: N
authors.lastname: Freemantle
authors.forename: Marcus
authors.initials: M
authors.lastname: Flather
authors.forename: Puvan
authors.initials: P
authors.lastname: Tharmanathan
authors.forename: Andrew
authors.initials: A
authors.lastname: Coats
authors.forename: Philip A
authors.initials: PA
authors.lastname: Poole-Wilson
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D001578:Benzopyrans / Q000191:economics / Q000627:therapeutic use*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D004983:Ethanolamines / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D000068577:Nebivolol; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D006113:United Kingdom
chemical_list: D000319:Adrenergic beta-Antagonists; D001578:Benzopyrans; D004983:Ethanolamines; D000068577:Nebivolol
references.citation: Eur J Heart Fail. 2002 Jun;4(3):361-71
references.pmid: 12034163
references.citation: Am J Cardiol. 1999 Mar 15;83(6):890-6
references.pmid: 10190405
references.citation: Curr Med Res Opin. 2006 Dec;22(12):2549-56
references.pmid: 17166337
references.citation: J Am Coll Cardiol. 1995 Apr;25(5):1154-61
references.pmid: 7897129
references.citation: Pharmacoeconomics. 2000 May;17(5):479-500
references.pmid: 10977389
references.citation: N Engl J Med. 1996 May 23;334(21):1349-55
references.pmid: 8614419
references.citation: J Health Serv Res Policy. 2004 Apr;9(2):110-8
references.pmid: 15099459
references.citation: Ann Pharmacother. 2001 Jul-Aug;35(7-8):846-51
references.pmid: 11485131
references.citation: Health Econ. 2006 Dec;15(12):1295-310
references.pmid: 16941543
references.citation: Am Heart J. 2001 Sep;142(3):537-43
references.pmid: 11526370
references.citation: Lancet. 1999 Jun 12;353(9169):2001-7
references.pmid: 10376614
references.citation: Lancet. 1999 Jan 2;353(9146):9-13
references.pmid: 10023943
references.citation: Eur Heart J. 1997 Feb;18(2):208-25
references.pmid: 9043837
references.citation: J Am Coll Cardiol. 1993 Oct;22(4 Suppl A):6A-13A
references.pmid: 8376698
references.citation: Eur Heart J. 2007 Jan;28(1):42-51
references.pmid: 17110403
references.citation: J Card Fail. 2005 Dec;11(9):647-56
references.pmid: 16360958
references.citation: Med Decis Making. 1993 Oct-Dec;13(4):322-38
references.pmid: 8246705
references.citation: Pharmacoeconomics. 2006;24(10):1011-20
references.pmid: 17002483
references.citation: Am J Med. 2004 Jan 15;116(2):104-11
references.pmid: 14715324
references.citation: Eur Heart J. 2005 Feb;26(3):215-25
references.pmid: 15642700
references.citation: Int J Geriatr Psychiatry. 1998 Jul;13(7):445-53
references.pmid: 9695032
references.citation: Kidney Int Suppl. 1997 Dec;63:S159-62
references.pmid: 9407447
references.citation: Eur Heart J. 2002 Jun;23(11):877-85
references.pmid: 12042009
references.citation: Eur J Heart Fail. 2001 Jun;3(3):351-7
references.pmid: 11378007