The costs of treating acute heart failure: an economic analysis of the SURVIVE trial.
OBJECTIVE
To estimate the incremental cost per life year gained with levosimendan relative to dobutamine in treatment of acute heart failure based on the Survival of Patients with Acute Heart Failure in Need of Intravenous Inotropic Support (SURVIVE) trial.


METHODS
SURVIVE enrolled 1,327 patients (levosimendan 664, dobutamine 663) from nine nations with 180-day survival from date of randomisation as the primary endpoint. Hospital resource utilisation was determined via clinical case reports. Unit costs were derived from hospital payment schedules for France, Germany and the UK, and represent a third-party payer perspective. Cost-effectiveness analysis was performed for a subset of the SURVIVE patient population selected in accordance with current levosimendan labeling.


RESULTS
Mortality in the levosimendan group was 26 versus 28% for dobutamine (hazard ratio 0.91, 95% confidence interval 0.74-1.13, p=0.40). Initial hospitalisation length of stay was identical (levosimendan 14.4, dobutamine 14.5, p=0.98). Slightly lower rates of readmission were observed for levosimendan relative to dobutamine at 31 (p=0.13) and 180 days (p=0.23). Mean costs excluding study drug were equivalent for the index admission (levosimendan euro5,060, dobutamine euro4,952; p=0.91) and complete episode (levosimendan euro5,396, dobutamine euro5,275; p=0.93).


CONCLUSIONS
At an acquisition cost of euro600 per vial, there is at least 50% likelihood that levosimendan is cost effective relative to dobutamine if willingness to pay is equal to or greater than euro15,000 per life year gained.
de Lissovoy
Gregory
G
United BioSource Corporation, Center for Health Economics, Epidemiology and Science Policy, Bethesda, MD 20814, USA. greg.delissovoy@unitedbiosource.com
Fraeman
Kathy
K
Salon
Jeff
J
Chay Woodward
Tatia
T
Sterz
Raimund
R
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004280:Dobutamine / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D006801:Humans; D006835:Hydrazones / Q000191:economics / Q000627:therapeutic use*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D011724:Pyridazines / Q000191:economics / Q000627:therapeutic use*; D000077464:Simendan
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D004280:Dobutamine