Cost-effectiveness of Levosimendan in Patients With Acute Heart Failure

Fedele, Francesco; D’Ambrosi, Alessandra; Bruno, Noemi; Caira, Carmen; Brasolin, Bruno; Mancone, Massimo

doi:10.1097/fjc.0b013e318224e0a2

Cited by 15 publications

(21 citation statements)

References 14 publications

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“…As far as comparison is possible, such outcomes appear to be in line with those which are reported in published clinical trials of levosimendan [15][16][17][18][19] and in a comprehensive meta-analysis [14], in particular with regards to shortened LOS; the gain of 1.5 days reported by Fedele et al [21] is the same as that reported by Landoni et al [14]. In other words, all these clinical findings appear to be confirmed by a "real-life" clinical experience in Italy.…”

Section: Discussionsupporting

confidence: 85%

“…in the reference study [21]). Such amount is defined in the model below (savings from rehospitalization rate reduction due to…”

Section: Savings From a Reduction In Rehospitalization Ratementioning

confidence: 89%

“…The present cost analysis was performed in order to evaluate the economic impact of This analysis exploits the real hospitalization outcomes from an Italian retrospective study [21].…”

Section: Discussionmentioning

confidence: 99%

“…No elicitation was performed in the reference study [21] on health state utility values in AHF, so data from other sources, which shall be reported here, have a purely orientative value.…”

Section: Discussionmentioning

confidence: 99%

“…i.e., by the number of days for which the hospital is reimbursed after the patient has been discharged (1.5 days in the reference study [21]). The definition used in the model is: savings from LOS reduction due to levosimendan (S LOS ).…”

Section: Savings From Los Reductionmentioning

confidence: 99%

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Economic Evaluation of Levosimendan Versus Dobutamine for the Treatment of Acute Heart Failure in Italy

Lucioni¹,

D’Ambrosi

Mazzi³

et al. 2012

Adv Therapy

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Inodilators are the first-choice class of drugs for the treatment of acute heart failure (AHF). Levosimendan is a relatively recent inodilatory agent, presenting superior outcomes in comparison with traditional inotropes. An economic evaluation of levosimendan for the treatment of AHF in Italy was performed. In a retrospective study conducted on patients with AHF admitted to a teaching hospital in Rome, two groups were derived from an observational registry: 147 patients treated with levosimendan and 145 treated with dobutamine. Follow-up was at 1 year after treatment. In the reference study looked at in this paper, treatment with levosimendan reduced mean length of stay (LOS) by 1.5 days (P < 0.05). Reduction in the rehospitalization rate was 6.7% (P < 0.05). Mortality rate at 1 month was reduced by 4.8% (P < 0.05). Based on the reference study, a cost analysis from the hospital perspective was carried out. The incremental cost of treatment with levosimendan (a,not sign697) was equivalent to the incremental savings (a,not sign694), the latter being obtained from the reduction in LOS (a,not sign508) and rehospitalization rate (a,not sign186). Despite the limitations of this study, and even neglecting all nonmonetary health gains as additional outcomes, levosimendan appears to be a competitive alternative compared with dobutamine for the treatment of AHF in the Italian hospital setting

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Section: Discussionsupporting

confidence: 85%

“…in the reference study [21]). Such amount is defined in the model below (savings from rehospitalization rate reduction due to…”

Section: Savings From a Reduction In Rehospitalization Ratementioning

confidence: 89%

“…The present cost analysis was performed in order to evaluate the economic impact of This analysis exploits the real hospitalization outcomes from an Italian retrospective study [21].…”

Section: Discussionmentioning

confidence: 99%

“…No elicitation was performed in the reference study [21] on health state utility values in AHF, so data from other sources, which shall be reported here, have a purely orientative value.…”

Section: Discussionmentioning

confidence: 99%

Section: Savings From Los Reductionmentioning

confidence: 99%

See 3 more Smart Citations

Economic Evaluation of Levosimendan Versus Dobutamine for the Treatment of Acute Heart Failure in Italy

Lucioni¹,

D’Ambrosi

Mazzi³

et al. 2012

Adv Therapy

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Comparison of salt with low-dose furosemide and carperitide for treating acute decompensated heart failure: a single-center retrospective cohort study

et al. 2016

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Hypertonic saline with furosemide has been proposed for a long time as an effective therapeutic option for the treatment of acute decompensated heart failure (ADHF). We previously reported the efficacy of continuous infusion of 1.7 % hypertonic saline plus low-dose furosemide in treatment for ADHF. Although this therapeutic strategy can be a useful option for effective decongestion in treatment for ADHF, there is no study that assesses the effect and safety of saline supplementation compared with standard therapy in Japan. The aim of this study was to investigate the efficacy, safety, and cost-effectiveness of 1.7 % hypertonic saline plus low-dose furosemide infusion compared with carperitide. We compared clinical outcomes, adverse events, and cost for patients receiving carperitide (carperitide group) with those for patients receiving 1.7 % hypertonic saline plus low-dose furosemide (salt group) during the initial hospitalization for ADHF. The cost analysis was performed on the basis of the previous report about cost-effectiveness of acute heart failure. A total of 175 ADHF patients received either carperitide (n = 111) or 1.7 % hypertonic saline plus low-dose furosemide infusion (n = 64) as initial treatment. There were no differences in length of hospital stay (27 ± 19 vs. 25 ± 16 day, p = 0.170) and infusion period (7.2 ± 6.1 vs. 8.4 ± 7.5 day, p = 0.474) between the two groups. The incidence of rehospitalization did not differ at 1 month (7.6 vs. 6.6 %, p = 1.000) and 1 year (36.8 vs. 37.7 %, p = 0.907) between the two groups. The Kaplan-Meier curves revealed no significant difference for 1 year all-cause mortality between the two groups (log-rank, p = 0.724). The single hospitalization cost was 95,314 yen lower and the yearly hospitalization cost 125,628 yen lower in the salt group compared with the carperitide group. Thus, intravenous 1.7 % hypertonic saline plus low-dose furosemide infusion is as effective as carperitide in terms of clinical outcome and is a cost-effective therapeutic strategy for the treatment of ADHF.

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Edoxaban versus warfarin for stroke prevention in non-valvular atrial fibrillation: a cost-effectiveness analysis

Rognoni

Marchetti

Quaglini

et al. 2014

J Thromb Thrombolysis

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Edoxaban, an oral direct factor Xa inhibitor, has been found non-inferior to warfarin for preventing stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF), with a lower rate of intracranial bleeding. The aim of our investigation was to assess the cost-effectiveness of edoxaban versus warfarin from the perspective of the Italian health-care system. A Markov decision model was used to evaluate lifetime cost and quality-adjusted life expectancy of NVAF patients treated with warfarin or edoxaban. Transition probabilities were obtained from the ENGAGE AF-TIMI 48 trial, cost estimates were based on Italian prices and tariffs, utilities were obtained from the literature. One-way and second-order sensitivity analyses were performed. In the base case, lifetime costs were €18,658 for edoxaban and €14,060 for warfarin. Discounted quality-adjusted survival was 9.022 years for edoxaban and 8.425 years for warfarin, leading to an incremental cost-utility ratio of €7,713 per quality-adjusted life year (QALY) gained. Results were sensitive to time horizon, time in therapeutic range of warfarin and to the relative impact of warfarin versus edoxaban therapy onto quality of life. Probabilistic sensitivity analysis showed edoxaban to be cost-effective versus warfarin in 92.3 % of the simulations at a willingness-to-pay threshold of €25,000 per QALY. In conclusion, edoxaban proved to be a cost-effective alternative to warfarin in patients with moderate-to-high-risk NVAF.

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Cost-effectiveness of Levosimendan in Patients With Acute Heart Failure

Cited by 15 publications

References 14 publications

Economic Evaluation of Levosimendan Versus Dobutamine for the Treatment of Acute Heart Failure in Italy

Economic Evaluation of Levosimendan Versus Dobutamine for the Treatment of Acute Heart Failure in Italy

Comparison of salt with low-dose furosemide and carperitide for treating acute decompensated heart failure: a single-center retrospective cohort study

Edoxaban versus warfarin for stroke prevention in non-valvular atrial fibrillation: a cost-effectiveness analysis

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