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The Pharmacoeconomics of ACE Inhibitors in Chronic Heart Failure

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Summary

Because heart failure is common and disabling, patients with this condition utilise healthcare resources to a considerable extent. In particular, patients with heart failure frequently require hospital admission, and inpatient care is often protracted. Patients with the most advanced stages of heart failure make the greatest demands on the healthcare system. Expenditure related to the consumption of healthcare resources accounts for the 1 to 2% of total healthcare spending related to heart failure. Between two-thirds and three-quarters of this is due to the costs of hospital care.

ACE inhibitors reduce progression of heart failure and also reduce the need for hospitalisation by approximately 30%. In so doing, these drugs substantially or totally offset their cost and the cost of extended life. Five independent economic analyses collectively show ACE inhibitors, at worst, to be very cost effective (in comparison to other cardiovascular therapies), cost neutral or to lead to overall cost savings when used to treat heart failure.

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References

  1. Kannel WB, Belanger AJ. Epidemiology of heart failure. Am Heart J 1991; 121: 9651–7

    Google Scholar 

  2. Eriksson H, Svardsudd K, Larsson B, et al. Risk factors for heart failure in the general population: the study of men born in 1913. Eur Heart J 1989; 10: 647–56

    PubMed  CAS  Google Scholar 

  3. Wheeldon NM, MacDonald TM, Flucker CJ, et al. Echocardiography in chronic heart failure in the community. Q J Med 1993; 86: 17–23

    PubMed  CAS  Google Scholar 

  4. Parameshwar J, Shackell MM, Richardson A, et al. Prevalence of heart failure in three general practices in north-west London. Br J Gen Pract 1992; 42: 287–9

    PubMed  CAS  Google Scholar 

  5. Schocken DD, Arrieta MI, Leaverton PE, et al. Prevalence and mortality rate of congestive heart failure in the United States. J Am Coll Cardiol 1992; 20: 301–6

    Article  PubMed  CAS  Google Scholar 

  6. Ghali JK, Cooper R, Ford E. Trends in hospitalisation rates for heart failure in the United States 1973-1986: evidence for increasing population prevalence. Arch Intern Med 1990; 150: 769–73

    Article  PubMed  CAS  Google Scholar 

  7. ISIS-2 Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of acute myocardial infarction: ISIS-2. Lancet 1988; ii: 349–59

    Google Scholar 

  8. Bonneux L, Barendregt JJ, Meeter K, et al. Estimating clinical morbidity due to ischaemic heart disease and congestive heart failure: the future rise of heart failure. Am J Public Health 1994; 84: 20–8

    Article  PubMed  CAS  Google Scholar 

  9. Stewart AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions: results from the medical outcomes study. JAMA 1989; 262: 907–13

    Article  PubMed  CAS  Google Scholar 

  10. Fryback DG, Dasbach EJ, Klein BE, et al. The Beaver Dam health outcomes study. Med Decis Making 1993; 13: 89–102

    Article  PubMed  CAS  Google Scholar 

  11. Eriksson H, Svardsudd K, Larsson B, et al. Quality of life in early heart failure. Scand J Prim Health Care 1986; 6: 161–7

    Article  Google Scholar 

  12. O’Connell JB, Bristow MR. Economic impact of heart failure in the United States: time for a different approach. J Heart Lung Transplant 1993; 13: S107–12

    Google Scholar 

  13. Parameshwar J, Poole-Wilson PA, Sutton GC. Heart failure in a district general hospital. J R Coll Physicians Lond 1992; 26: 139–42

    PubMed  CAS  Google Scholar 

  14. McMurray J, McDonagh T, Morrison CE, et al. Trends in hospitalisation for chronic heart failure in Scotland. Eur Heart J 1993; 14: 1158–62

    Article  PubMed  CAS  Google Scholar 

  15. Gillum RF. Epidemiology of heart failure in the United States. Am Heart J 1993; 26: 1042–7

    Article  Google Scholar 

  16. Andersson B, Waagstein F. Spectrum and outcome of congestive heart failure in a hospitalized population. Am Heart J 1993; 126: 632–40

    Article  PubMed  CAS  Google Scholar 

  17. Eriksson H, Svärdsudd K, Larsson B, et al. Epidemiology and prognosis of heart failure. Z Kardiol 1991; 80 Suppl. 8: 1–6

    PubMed  Google Scholar 

  18. Yancy CW, Firth BG. Congestive heart failure. Dis Mon 1988 Aug; 34: 465–536

    Google Scholar 

  19. Studies of Left Ventricular Dysfunction (SOLVD) Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991; 325: 293–302

    Article  Google Scholar 

  20. Brophy JM, Deslauriers G, Boucher B, et al. The hospital course and short term prognosis of patients presenting to the emergency room with decompensated congestive heart failure. Can J Cardiol 1993; 9 (3): 219–24

    PubMed  CAS  Google Scholar 

  21. Weingarten SR, Reidinger MS, Shinbane J, et al. Triage practice guideline for patients hospitalized with congestive heart failure: improving effectiveness of the coronary care unit. Am J Med 1993; 94: 483–90

    Article  PubMed  CAS  Google Scholar 

  22. Vinson JM, Rich MW, Sperry JC, et al. Early readmission of elderly patients with congestive heart failure. J Am Geriatr Soc 1990; 38: 1290–5

    PubMed  CAS  Google Scholar 

  23. Gooding J, Jette AM. Hospital readmissions among the elderly. J Am Geriatr Soc 1985; 33: 595–601

    PubMed  CAS  Google Scholar 

  24. Ho KKL, Anderson KM, Karmel WB, et al. Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation 1993; 88: 107–15

    Article  PubMed  CAS  Google Scholar 

  25. CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. N Engl J Med 1987; 316: 1429–35

    Article  Google Scholar 

  26. Launois R, Launois B, Reboul—Marty J, et al. Le côut de la séverité de la maladie: le cas de l’insuffisance—cardiaque. J Econ Med 1990; 8: 395–412

    Google Scholar 

  27. McMurray J, Hart W, Rhodes G. An evaluation of the cost of heart failure to the National Health Service in the UK. Br J Med Econ 1993; 6: 91–98

    Google Scholar 

  28. van Hout BA, Wielink G, Bonsel GJ, et al. Effects of ACE inhibitors on heart failure in The Netherlands: a pharmacoeconomic model. PharmacoEconomics 1993; 3: 387–97

    Article  PubMed  Google Scholar 

  29. Action asthma. The occurrence and cost of asthma. Cambridge (England): Cambridge Medical Publications, 1990

    Google Scholar 

  30. Drummond MF, Ward GH. The financial burden of stroke. In: Rose CF, editor. Stroke: epidemiological, therapeutic and socioeconomic aspects. International Congress and Symposium Series No. 99. Oxford: Oxford University Press, 1986: 147–62

    Google Scholar 

  31. Kulbertus HE. What has long-term medical treatment to offer and what does it cost? Eur Heart J 1987; 8 Suppl. F: 26–8

    PubMed  Google Scholar 

  32. Kleber FX, Niemoller L, Rohrbacher R. Sozio-okonomische bedeutung der ACE-hemmer bei fruhformen der herzinsuffizienz. Munch Med Wochenschr 1992; 134: 749–52

    Google Scholar 

  33. Cohn JN, Archibald DG, Siesche S, et al. Effect of vasodilator therapy in mortality in chronic congestive heart failure: results of a Veterans Affairs Administration cooperative study. N Engl J Med 1986; 314: 1547–52

    Article  PubMed  CAS  Google Scholar 

  34. Cohn JN, Johnson G, Ziesche S, et al. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 1991; 325: 303–10

    Article  PubMed  CAS  Google Scholar 

  35. Kleber FX, Niemoller L, Doering W. Impact of converting enzyme inhibition on progression of chronic heart failure: results of the Munich mild heart failure trial. Br Heart J 1992; 67: 289–96

    Article  PubMed  CAS  Google Scholar 

  36. Glick H, Cook J, Kinosian B, et al. Costs and effects of enalapril therapy in patients with symptomatic heart failure: an economic analysis of the Studies of Left Ventricular Dysfunction (SOLVD) Treatment Trial. J Cardiac Failure 1995; 1 (5): 371–80

    Article  CAS  Google Scholar 

  37. Captopril-Digoxin Multicenter Research Group (CDMRG). Comparative effects of therapy with captopril and digoxin in patients with mild to moderate heart failure. JAMA 1988; 259: 539–44

    Article  Google Scholar 

  38. Kjekshus JD, Sedberg K, for the CONSENSUS Trial Study Group. Tolerability of enalapril in congestive heart failure. Am J Cardiol 1988; 62 Suppl. A: 67A–72A

    Article  PubMed  CAS  Google Scholar 

  39. Pfeffer MA, Braunwald E, Moyél A, et al. Effect of captopril in mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the Survival and Ventricular Enlargement Trial. N Engl J Med 1992; 327: 669–77

    Article  PubMed  CAS  Google Scholar 

  40. Studies of Left Ventricular Dysfunction (SOLVD) Investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med 1992; 327: 685–91

    Article  Google Scholar 

  41. Loeb HS, Johnson G, Henrick A, et al. Effect of enalapril, hydralazine plus isosorbide dinitrate and prazosin in hospitalisation in patients with chronic congestive heart failure. Circulation 1993; 87 Suppl. VI: VI78–87

    Google Scholar 

  42. Paul SD, Kuntz KM, Eagle KA, et al. Costs and effectiveness of angiotensin converting enzyme inhibition in patients with congestive heart failure. Arch Intern Med 1994; 154: 1143–9

    Article  PubMed  CAS  Google Scholar 

  43. Love MP, McMurray JJV. Paying the price of treating heart failure: the cost-effectiveness of ACE inhibitors. Br J Cardiol 1994 May; 1: 202–7

    Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Western General Hospitals NHS Trust, Edinburgh, Scotland

    John McMurray & Andrew Davie

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  1. John McMurray
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  2. Andrew Davie
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McMurray, J., Davie, A. The Pharmacoeconomics of ACE Inhibitors in Chronic Heart Failure. Pharmacoeconomics 9, 188–197 (1996). https://doi.org/10.2165/00019053-199609030-00002

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