Health economics of heart failure.

The pharmacoeconomics of heart failure are relatively easy to analyse for two reasons. Firstly, suYcient data on resource utilisation, such as hospital bed days or drug consumption, are available; net patient costs are easily identifiable and measurable in monetary terms. Secondly, the outcome, in terms of mortality, morbidity, and lost quality of life, is also straightforward to measure owing to a number of large clinical trials which have been performed in patients with heart failure. Despite this, however, very few pharmacoeconomic evaluations of â blockers in heart failure have been carried out. The treatment costs of heart failure are relatively high. It has been estimated that in western industrialised countries, between 1–2% of total annual health care expenditure is related to the care of patients with heart failure. In the US patients with heart failure have been said to account for 1.5% of health care expenditure, while in France the figure is quoted as being as high as 1.9%. 3 In the UK and the Netherlands, the equivalent percentages are 1.2% and about 1%, respectively. 5 These figures, however, have been calculated from data that are up to 10 years old (table 1). In heart failure, costs are driven mainly by hospital admission charges and are relatively constant between health care systems as a proportion, representing 67–75% of the total cost of treating a patient. There is also a positive correlation between the cost of heart failure treatment for a particular individual and the severity of their disease. The relation is non-linear and rises almost exponentially as the New York Heart Association (NYHA) class of heart failure goes up. Looking at the various figures from publications relating to diVerent countries it is apparent that costs almost double with the jump between NYHA class I/II and III. There is also a major cost diVerential between treating patients with NYHA class III and class IV heart failure (table 2).