Reed Shelby D, Friedman Joëlle Y, Velazquez Eric J, Gnanasakthy Ari, Califf Robert M, Schulman Kevin A
Center for Clinical and Genetic Economics, Durham, NC, USA.
Am Heart J. 2004 Jul;148(1):122-8. doi: 10.1016/j.ahj.2003.12.040.
The Valsartan Heart Failure Trial (Val-HeFT) compared valsartan versus placebo in 5010 patients taking prescribed background therapy for New York Heart Association class II to IV heart failure. Valsartan reduced the risk of heart failure hospitalization and improved clinical signs and symptoms of heart failure. We sought to compare resource use, costs, and health outcomes among patients taking prescribed therapy for heart failure and randomly assigned to receive valsartan or placebo.
Measures of resource use were based on data collected during the trial. Unit cost estimates were collected from individual countries and converted to 1999 US dollars. Total costs were estimated for hospitalizations, inpatient and outpatient physician services, ambulance transportation, deaths outside the hospital, and outpatient cardiovascular medications.
Mean follow-up was 23 months. Mean costs for heart failure hospitalizations were 423 dollars lower among patients receiving valsartan (95% CI, -706 to -146). Mean total costs were 9008 dollars for patients receiving valsartan and 8464 dollars for patients receiving placebo, a net incremental cost of 545 dollars (95% CI, -149 to 1148), including the cost of valsartan. There was an overall reduction in total costs of 929 dollars (95% CI, -3243 to 1533) among patients not receiving an ACE inhibitor at baseline but a slight increase in costs of 334 dollars (95% CI, -497 to 1199) among those receiving an ACE inhibitor without a beta-blocker and a 1246 dollars increase (95% CI, 54 to 2230) in patients receiving both an ACE inhibitor and a beta-blocker at baseline.
Valsartan provided clinical benefits at a mean incremental cost of 285 dollars per year during the trial. In patients not taking ACE inhibitors, valsartan was economically attractive, increasing survival while reducing or marginally increasing overall costs.
缬沙坦心力衰竭试验（Val-HeFT）在5010例接受纽约心脏病协会II至IV级心力衰竭常规背景治疗的患者中比较了缬沙坦与安慰剂。缬沙坦降低了心力衰竭住院风险，并改善了心力衰竭的临床体征和症状。我们试图比较接受心力衰竭常规治疗并随机分配接受缬沙坦或安慰剂的患者之间的资源使用、成本和健康结局。
资源使用的测量基于试验期间收集的数据。单位成本估计值从各个国家收集并换算为1999年美元。估计了住院、住院和门诊医生服务、救护车运输、院外死亡以及门诊心血管药物的总成本。
平均随访23个月。接受缬沙坦治疗的患者心力衰竭住院平均成本低423美元（95%CI，-706至-146）。接受缬沙坦治疗的患者平均总成本为9008美元，接受安慰剂治疗的患者为8464美元，净增量成本为545美元（95%CI，-149至1148），包括缬沙坦的成本。基线时未接受ACE抑制剂的患者总成本总体降低929美元（95%CI，-3243至1533），但接受ACE抑制剂但未接受β受体阻滞剂的患者成本略有增加334美元（95%CI，-497至1199），基线时同时接受ACE抑制剂和β受体阻滞剂的患者成本增加1246美元（95%CI，54至2230）。
在试验期间，缬沙坦以每年平均285美元的增量成本提供了临床益处。在未服用ACE抑制剂的患者中，缬沙坦在经济上具有吸引力，可提高生存率，同时降低或略微增加总体成本。
