title: Economic evaluation of ivabradine in the treatment of chronic heart failure in Greece.
abstract: BACKGROUND
  The objective of our study was to assess the cost-effectiveness of ivabradine plus standard care (SoC) in chronic heart failure (CHF) patients with sinus rhythm and a baseline heart rate ≥ 75 b.p.m. in Greece, in comparison with current SoC alone.
  
  
  METHODS
  An existing cost-effectiveness model consisting of two health states, was adapted to the Greek health care setting. All clinical inputs of the model (i.e. mortality rates, hospitalization rates, NYHA class distribution and utility values) were estimated from SHIFT trial data. All costing data used in the model reflects the year 2013 (in €). An incremental cost effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained was calculated. Deterministic and probabilistic sensitivity analyses (PSA) were conducted. The horizon of analysis was over patient life time and both cost and outcomes were discounted at 3.5% per year. The analysis was conducted from a Greek third party-payer perspective.
  
  
  RESULTS
  The Markov analysis revealed that the discounted quality-adjusted survival was 4.27 and 3.99 QALYs in the ivabradine plus SoC and SoC alone treatment arms, respectively. The cumulative lifetime total cost per patient was €8,665 and €5,873, for ivabradine plus SoC and SoC alone, respectively. The ICER for ivabradine plus SoC versus SoC alone was estimated as €9,986 per QALY gained. The PSA showed that the likelihood of ivabradine plus SoC being cost-effective at a threshold of €36,000/QALY was found to be 95%.
  
  
  CONCLUSIONS
  Ivabradine plus SoC may be regarded as a cost-effective option for the treatment in CHF patients in Greece.
authors.affiliation: The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), National and Kapodistrian University of Athens, School of Medicine, Athens, Greece. kurlaba@hua.gr.
authors.forename: Georgia
authors.initials: G
authors.lastname: Kourlaba
authors.forename: John
authors.initials: J
authors.lastname: Parissis
authors.forename: Apostolos
authors.initials: A
authors.lastname: Karavidas
authors.forename: Alexandra
authors.initials: A
authors.lastname: Beletsi
authors.forename: Charalambos
authors.initials: C
authors.lastname: Milonas
authors.forename: Neil
authors.initials: N
authors.lastname: Branscombe
authors.forename: Nikos
authors.initials: N
authors.lastname: Maniadakis
mesh_terms: D001552:Benzazepines / Q000191:economics* / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000191:economics* / Q000627:therapeutic use*; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D006115:Greece; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D000077550:Ivabradine; D007902:Length of Stay / Q000706:statistics & numerical data; D008390:Markov Chains; D019057:Quality-Adjusted Life Years
chemical_list: D001552:Benzazepines; D002317:Cardiovascular Agents; D000077550:Ivabradine