Key result
Contemporary GDMT is linked to ~39% lower mortality in decompensated HFrEF despite higher medication costs.
Why the study?
Recent evolution in GDMT provides clinical benefits in HFrEF, but additional medical expenditure is a concern due to financial constraints.
Does contemporary GDMT including sacubitril/valsartan improve clinical outcomes and what are the associated medical costs in acutely decompensated HFrEF patients?
Cohort (n=1,278)
Yes
Does contemporary GDMT including sacubitril/valsartan improve clinical outcomes and what are the associated medical costs in acutely decompensated HFrEF patients?
Absolute Event Rate: 48.8% vs 79.9%
p-value: p=<0.001
Contemporary GDMT including sacubitril/valsartan in decompensated HFrEF patients is associated with higher medical costs but significantly lower rates of mortality and heart failure hospitalizations compared to historical therapy.
Supports considering GDMT despite higher costs in decompensated HFrEF; leaves open need for RCTs to confirm benefit.
BACKGROUND: Over recent years, new evolution in guideline-directed medical therapy (GDMT) contributes to clinical benefits in patients with heart failure and reduced ejection fraction (HFrEF). The additional medical expenditure may be a concern due to the current financial constraint. This study aimed to investigate the medical costs and clinical effectiveness of contemporary GDMT in recently hospitalized HFrEF patients. METHODS: Acutely decompensated hospitalized HFrEF patients from two multicenter cohorts of different periods were retrospectively analyzed. A propensity score matching was performed to adjust the baseline characteristics. Annual medication costs, risks of mortality, and recurrent heart failure hospitalizations (HFH) were compared. RESULTS: Following 1:2 propensity score matching, there were 426 patients from the 2017-2018 cohort using sacubitril/valsartan, while 852 patients from 2013 to 2014 did not use so at discharge. Baseline characteristics were similar, whereas the sacubitril/valsartan users were more likely to receive beta-blockers, ivabradine and mineralocorticoid receptor antagonists at discharge (79.3% vs 60.4%, 23.2% vs 0%, and 64.1% vs 49.8%, p < 0.001). The 2017-2018 cohort produced more medication costs by 1277 United States dollar (USD) per person per year, while it resulted in lower rates of HFH and all-cause mortality (10.3 vs 20.3 and 48.8 vs 79.9 per 100 person-year, p < 0.001). Costs of preventing a mortality event and a HFH event with contemporary treatments were 15 758 USD (95% confidence interval [CI] 10 436-29 244) and 5317 USD (95% CI 3388-10 098), respectively. CONCLUSION: The higher adoption of GDMT was associated with greater medical expenses but better clinical outcomes in recently decompensated HFrEF patients.
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Liang et al. (2021) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=1,278). Contemporary GDMT (including sacubitril/valsartan) vs. Historical GDMT (without sacubitril/valsartan) was evaluated on All-cause mortality (p=<0.001). Contemporary GDMT including sacubitril/valsartan increased annual medication costs but reduced all-cause mortality (48.8 vs 79.9 per 100 person-years; P<0.001) in decompensated HFrEF patients.
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