Development of an economic model to assess the cost-effectiveness of hawthorn extract as an adjunct treatment for heart failure in Australia

Abstract

ObjectiveAn economic model was developed to evaluate the cost-effectiveness of hawthorn extract as an adjunctive treatment for heart failure in Australia.MethodsA Markov model of chronic heart failure was developed to compare the costs and outcomes of standard treatment and standard treatment with hawthorn extract. Health states were defined by the New York Heart Association (NYHA) classification system and death. For any given cycle, patients could remain in the same NYHA class, experience an improvement or deterioration in NYHA class, be hospitalised or die. Model inputs were derived from the published medical literature, and the output was quality-adjusted life years (QALYs). Probabilistic sensitivity analysis was conducted. The expected value of perfect information (EVPI) and the expected value of partial perfect information (EVPPI) were conducted to establish the value of further research and the ideal target for such research.ResultsHawthorn extract increased costs by $1866.78 and resulted in a gain of 0.02 QALYs. The incremental cost-effectiveness ratio was $85 160.33 per QALY. The cost-effectiveness acceptability curve indicated that at a threshold of $40 000 the new treatment had a 0.29 probability of being cost-effective. The average incremental net monetary benefit (NMB) was −$1791.64, the average NMB for the standard treatment was $92 067.49, and for hawthorn extract $90 275.84. Additional research is potentially cost-effective if research is not proposed to cost more than $325 million. Utilities form the most important target parameter group for further research.ConclusionsHawthorn extract is not currently considered to be cost-effective in as an adjunctive treatment for heart failure in Australia. Further research in the area of utilities is warranted.

Critical review of complementary and alternative medicine use in menopause

“…94,95 In general, this review delineates the prevalence rates of CAM use and looks at possible reasons for use. Yet, only a small number of articles have, to date, focused on the influence of economic status on menopausal women regarding their decision to use or reject CAM.…”

Cost-utility analysis of percutaneous mitral valve repair in inoperable patients with functional mitral regurgitation in German settings

“…The probability of hospitalization due to worsening of heart failure was derived from the literature [ 21 ]. Age- and gender-specific general mortality was derived from German life tables [ 6 ].…”

Potential economic consequences of a cardioprotective agent for patients with myocardial infarction: modelling study

“… 9 11 Clinical input parameters are shown in table 1 . Transition probabilities between the different NYHA classes were derived from a randomised trial 12 as in previous cost-effectiveness studies of HF treatment 13 14 ( table 2 ). Age-specific long-term mortality data of myocardial infarction patients were used to determine the mortality of patients in the ‘No HF’ or ‘NYHA class I’ state.…”

“…These data, as well as the probability of hospitalisation in the different NYHA classes, were derived from a cost-effectiveness study on the treatment of HF. 13 …”