title: Cost-benefits of incorporating levosimendan into cardiac surgery practice: German base case.
abstract: OBJECTIVE
  To evaluate the cost-benefit of using levosimendan compared with dobutamine, in the perioperative treatment of patients undergoing cardiac surgery who require inotropic support.
  
  
  METHODS
  A two-part Markov model was designed to simulate health-state transitions of patients undergoing cardiac surgery, and estimate the short- and long-term health benefits of treatment. Hospital length of stay (LOS), mortality, medication, and adverse events were key clinical- and cost-inputs. Cost-benefits were evaluated in terms of costs and bed stays within the German healthcare system. Drug prices were calculated from the German Drug Directory (€/2014) and published literature, with a 3% annual discount rate applied. The base case analysis was for a 1-year time horizon.
  
  
  RESULTS
  The use of levosimendan vs dobutamine was associated with cost savings of €4787 per patient from the German hospital perspective due to reduced adverse events and shorter hospital LOS, leading to increased bed capacity and hospital revenue.
  
  
  CONCLUSIONS
  A pharmacoeconomic calculation for the specific situation of the German healthcare system that is based on international clinical trial carries a substantial risk of disregarding potentially relevant but unknown confounding factors (i.e., ICU-staffing, co-medications, standard-ICU care vs fast-tracking, etc.) that may either attenuate or increase the outcome pharmacoeconomic effects of a drug; however, since these conditions would also apply for patients treated with comparators, their net effects may not necessarily influence the conclusions.
  
  
  CONCLUSIONS
  The use of levosimendan in patients undergoing cardiac surgery who require inotropic support appears to be cost-saving. The results of the analysis provide a strong rationale to run local clinical studies with pharmacoeconomic end-points which would allow a much more precise computation of the benefits of levosimendan.
authors.affiliation: a a PAREXEL International , London , UK.
authors.forename: Silvy
authors.initials: S
authors.lastname: Mardiguian
authors.affiliation: b b Orion Pharma, Critical Care , Espoo , Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Kivikko
authors.affiliation: c c Clinic for Anesthesiology and Intensive Care Medicine, Universitätsklinikum Schleswig-Holstein , Lübeck , Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Heringlake
authors.affiliation: a a PAREXEL International , London , UK.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Smare
authors.affiliation: a a PAREXEL International , London , UK.
authors.forename: Evelina
authors.initials: E
authors.lastname: Bertranou
authors.affiliation: b b Orion Pharma, Critical Care , Espoo , Finland.
authors.forename: Marjo
authors.initials: M
authors.lastname: Apajasalo
authors.affiliation: b b Orion Pharma, Critical Care , Espoo , Finland.
authors.forename: Piero
authors.initials: P
authors.lastname: Pollesello
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004280:Dobutamine / Q000191:economics / Q000627:therapeutic use; D005858:Germany; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D007348:Insurance, Health / Q000191:economics; D007902:Length of Stay; D008390:Markov Chains; D017059:Models, Econometric; D011724:Pyridazines / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D000077464:Simendan
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D004280:Dobutamine
keywords: Cardiac surgery – Pharmacoeconomics – Health-economics – Cardiovascular complications – Hospital length-of-stay – Inotropes