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

Abstract

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

The patient perspective: Quality of life in advanced heart failure with frequent hospitalisations

“…In the REVIVE II trial an improvement in dyspnoea by levosimendan as compared to placebo was shown [62]. In the LevoRep trial, the effects of repetitive levosimendan infusions on 6-minute walk test, KCCQ clinical summary score, and event-free survival were described [63] In a recent comparison with dobutamine, levosimendan significantly reduced re-hospitalisation rates and shortened the length of hospital stay in acute heart failure by 1.5 days [64,65].…”

Utilisation du levosimendan chez l’enfant

“…Pourtant plusieurs études médico-économiques ont montré que, chez l'adulte, l'utilisation de cette molécule permettait de réduire le coût global d'hospitalisation [63]. En effet, la durée totale d'hospitalisation des patients traités par levosimendan semblait plus courte que celle des patients ayant reçu de la dobutamine, et le taux de réhospitalisation était également moindre.…”

Pharmaco-economics of levosimendan in cardiology: A European perspective

“…The inodilator levosimendan appears to meet these expectations [4]. Its pharmacological effects include increased cardiac contractility, achieved without increased oxygen consumption, combined with vasodilation [5], which is often considered a suitable pharmacological strategy in acute heart failure when patients are 'wet and cold' [6].…”

“…Furthermore, a greater proportion of days spent alive and outside hospital [11] and shorter hospital stay [14][15][16] is achieved for levosimendan-treated patients compared to those who receive dobutamine or placebo. The pharmaco-economic aspects of levosimendan therapy have been previously addressed in studies that have described both costeffectiveness and cost-reduction, using different well-established pharmaco-economic methods [4,[16][17][18][19][20]. One of these was an evaluation by Lucioni et al [4] that was based on a retrospective study conducted in patients with acute HF, who had been treated with either levosimendan (n = 147) or dobutamine (n = 145) at a teaching hospital in Rome.…”

“…The pharmaco-economic aspects of levosimendan therapy have been previously addressed in studies that have described both costeffectiveness and cost-reduction, using different well-established pharmaco-economic methods [4,[16][17][18][19][20]. One of these was an evaluation by Lucioni et al [4] that was based on a retrospective study conducted in patients with acute HF, who had been treated with either levosimendan (n = 147) or dobutamine (n = 145) at a teaching hospital in Rome. Compared to dobutamine, the administration of levosimendan significantly reduced the mean length of hospital stay (LOS) by 1.5 days, decreased the re-hospitalization rate by 6.7%, and the 1-month mortality rate by 4.8%.…”