title: Cost-Effectiveness of Ivabradine for Heart Failure in the United States.
abstract: Ivabradine is a heart rate-lowering agent approved to reduce the risk of hospitalization for worsening heart failure. This study assessed the cost-effectiveness of adding ivabradine to background therapy in the United States from the perspective of a commercial or Medicare Advantage payer.
  
  
  
  A cost-effectiveness, cohort-based Markov model using a state transition approach tracked a cohort of heart failure patients with heart rate ≥70 beats per minute in sinus rhythm who were treated with ivabradine+background therapy or background therapy alone. Model inputs, including adjusted hazard ratios, rates of hospitalization and mortality, adverse events, and utility-regression equations, were derived from a large US claims database and SHIFT (Systolic Heart failure treatment with the If inhibitor ivabradine Trial). In the commercial population, ivabradine+background therapy was associated with a cost savings of $8594 versus the cost of background therapy alone over a 10-year time horizon, primarily because of reduced hospitalization. Ivabradine was associated with an incremental benefit of 0.24 quality-adjusted life years over a 10-year time horizon. In the Medicare Advantage population, the incremental cost-effectiveness ratio for ivabradine was estimated to be $24 920/quality-adjusted life years.
  
  
  
  The cost-effectiveness model suggests that for a commercial population, the addition of ivabradine to background therapy was associated with cost savings and improved clinical outcomes. For a Medicare Advantage population, the analysis indicates that the clinical benefit of ivabradine can be achieved at a reasonable cost.
authors.affiliation: Evidera, Bethesda, MD anuraag.kansal@evidera.com.
authors.forename: Anuraag R
authors.initials: AR
authors.lastname: Kansal
authors.affiliation: Imperial College London, London, United Kingdom.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Cowie
authors.affiliation: Amgen Inc., Thousand Oaks, CA.
authors.forename: Adrian
authors.initials: A
authors.lastname: Kielhorn
authors.affiliation: Evidera, Montreal, Quebec, Canada.
authors.forename: Stanimira
authors.initials: S
authors.lastname: Krotneva
authors.affiliation: Evidera, Bethesda, MD.
authors.forename: Ali
authors.initials: A
authors.lastname: Tafazzoli
authors.affiliation: Evidera, Bethesda, MD.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Amgen Inc., Thousand Oaks, CA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Yurgin
mesh_terms: D000368:Aged; D001552:Benzazepines / Q000191:economics / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D006339:Heart Rate; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D000077550:Ivabradine; D008297:Male; D008390:Markov Chains; D020398:Medicare Part C; D008875:Middle Aged; D016016:Proportional Hazards Models; D019057:Quality-Adjusted Life Years; D014481:United States
chemical_list: D001552:Benzazepines; D002317:Cardiovascular Agents; D000077550:Ivabradine
keywords: cost‐effectiveness; heart failure; heart rate; hospitalization