Reduced costs with bisoprolol treatment for heart failure; an economic analysis of the second Cardiac Insufficiency Bisoprolol Study (CIBIS-II)

Background Beta-blockers, used as an adjunctive to diuretics, digoxin and angiotensin converting enzyme inhibitors, improve survival in chronic heart failure. We report a prospectively planned economic analysis of the cost of adjunctive beta-blocker therapy in the second Cardiac Insufficiency BIsopr...

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Bibliographic Details
Published in:European heart journal 2001-06, Vol.22 (12), p.1021-1031
Format: Article
Language:English
Subjects:
Adrenergic beta-Antagonists - economics
Adrenergic beta-Antagonists - therapeutic use
Biological and medical sciences
Bisoprolol - economics
Bisoprolol - therapeutic use
Cardiovascular system
Chemotherapy, Adjuvant - economics
Cost-Benefit Analysis
France - epidemiology
Germany - epidemiology
Heart Failure - drug therapy
Heart Failure - economics
Heart Failure - mortality
Hospitalization - statistics & numerical data
Humans
Medical sciences
Pharmacology. Drug treatments
Prospective Studies
Quality-Adjusted Life Years
United Kingdom - epidemiology
Vasodilator agents. Cerebral vasodilators
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Summary:Background Beta-blockers, used as an adjunctive to diuretics, digoxin and angiotensin converting enzyme inhibitors, improve survival in chronic heart failure. We report a prospectively planned economic analysis of the cost of adjunctive beta-blocker therapy in the second Cardiac Insufficiency BIsoprolol Study (CIBIS II). Methods Resource utilization data (drug therapy, number of hospital admissions, length of hospital stay, ward type) were collected prospectively in all patients in CIBIS II. These data were used to determine the additional direct costs incurred, and savings made, with bisoprolol therapy. As well as the cost of the drug, additional costs related to bisoprolol therapy were added to cover the supervision of treatment initiation and titration (four outpatient clinic/office visits). Per diem (hospital bed day) costings were carried out for France, Germany and the U.K. Diagnosis related group costings were performed for France and the U.K. Our analyses took the perspective of a third party payer in France and Germany and the National Health Service in the U.K. Results Overall, fewer patients were hospitalized in the bisoprolol group, there were fewer hospital admissions per patient hospitalized, fewer hospital admissions overall, fewer days spent in hospital and fewer days spent in the most expensive type of ward. As a consequence the cost of care in the bisoprolol group was 5–10% less in all three countries, in the per diem analysis, even taking into account the cost of bisoprolol and the extra initiation/up-titration visits. The cost per patient treated in the placebo and bisoprolol groups was FF35009 vs FF31762 in France, DM11563 vs DM10784 in Germany and £4987 vs £4722 in the U.K. The diagnosis related group analysis gave similar results. Interpretation Not only did bisoprolol increase survival and reduce hospital admissions in CIBIS II, it also cut the cost of care in so doing. This ‘win–win’ situation of positive health benefits associated with cost savings is favourable from the point of view of both the patient and health care systems. These findings add further support for the use of beta-blockers in chronic heart failure.
ISSN:0195-668X
1522-9645
DOI:10.1053/euhj.2000.2532