Cost-effectiveness of Pharmacist- and Nurse Practitioner-led Medication Management for Heart Failure With Reduced Ejection Fraction

BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) reduces survival, increases the risk of hospitalization, and decreases quality of life. Despite high-quality evidence to support the benefits of guideline-directed medical therapy (GDMT) for patients with HFrEF, use of these medications remains suboptimal. Outpatient HFrEF medication management led by a pharmacist or nurse practitioner improves GDMT uptake, but the cost-effectiveness of such approaches is unknown. METHODS: We developed a 3-state Markov model (outpatient, hospitalized, or deceased) and compared additional pharmacist- and/or nurse practitioner-led HFrEF medication management with usual care alone. The model simulated a cohort of patients recently diagnosed with HFrEF within British Columbia, Canada. Outcomes included quality-adjusted life-year (QALY), costs, incremental cost-effectiveness ratio, and net monetary benefit (NMB) at a willingness-to-pay threshold of CAD$50,000 per QALY, over a lifetime horizon from a public payer perspective. RESULTS: Pharmacist- and/or nurse practitioner-led medication management reduced deaths (from 7.2 to 6.2 per 100 patients; mean difference, 1.0; 95% credible interval, 0.2-2.5) and heart failure hospitalizations (from 10.8 to 8.4 per 100 patients; mean difference, 2.4; 95% credible interval, 0.7-5.2) at 1 year compared with usual care. Pharmacist- and/or nurse practitioner-led medication management increased both QALYs (+1.76) and costs (+CAD$13,089), resulting in an incremental cost-effectiveness ratio of CAD$7437 per QALY and an incremental NMB of CAD$75,032. These results were robust across 1-way sensitivity analyses (incremental NMB ≥ CAD$46,611). CONCLUSIONS: For patients with recently diagnosed HFrEF, pharmacist- and/or nurse practitioner-led medication management is cost-effective, supporting the expansion of this care to improve GDMT uptake and patient outcomes.