Medical resource use, costs, and quality of life in patients with acute decompensated heart failure: findings from ASCEND-HF.
BACKGROUND
The Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) randomly assigned 7,141 participants to nesiritide or placebo. Dyspnea improvement was more often reported in the nesiritide group, but there were no differences in 30-day all-cause mortality or heart failure readmission rates. We compared medical resource use, costs, and health utilities between the treatment groups.


RESULTS
There were no significant differences in inpatient days, procedures, and emergency department visits reported for the first 30 days or for readmissions to day 180. EQ-5D health utilities and visual analog scale ratings were similar at 24 hours, discharge, and 30 days. Billing data and regression models were used to generate inpatient costs. Mean length of stay from randomization to discharge was 8.5 days in the nesiritide group and 8.6 days in the placebo group (P = .33). Cumulative mean costs at 30 days were $16,922 (SD $16,191) for nesiritide and $16,063 (SD $15,572) for placebo (P = .03). At 180 days, cumulative costs were $25,590 (SD $30,344) for nesiritide and $25,339 (SD $29,613) for placebo (P = .58).


CONCLUSIONS
The addition of nesiritide contributed to higher short-term costs and did not significantly influence medical resource use or health utilities compared with standard care alone.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina. Electronic address: shelby.reed@duke.edu.
Shelby D
SD
Reed
Padma
P
Kaul
Yanhong
Y
Li
Zubin J
ZJ
Eapen
Linda
L
Davidson-Ray
Kevin A
KA
Schulman
Barry M
BM
Massie
Paul W
PW
Armstrong
Randall C
RC
Starling
Christopher M
CM
O'Connor
Adrian F
AF
Hernandez
Robert M
RM
Califf
D000208:Acute Disease; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000191:economics* / Q000627:therapeutic use; D011788:Quality of Life / Q000523:psychology; D016896:Treatment Outcome
D020097:Natriuretic Peptide, Brain
Heart failure; brain; costs and cost analysis; natriuretic peptide; nesiritide