Cardiovascular therapies in the critically ill: economic and cost-effectiveness evaluations

Therapeutic strategies centered on the cardiovascular system are important for the management of critically ill patients, especially in acute heart failure or in sepsis. Economic analysis of those strategies are increasingly demanded because of financial restrictions in our health care system. However, valid data based on comprehensive economic investigations are scarce in medical literature. Thrombolytic therapy after acute myocardial infarction and angiotensin-converting enzyme blockers proved to have desirable cost—benefit ratios. Coronary revascularization by percutaneous transluminal coronary angioplasty is substantially more expensive than medical therapy but significantly less expensive than coronary artery bypass graft surgery, and was found to be reasonably cost-effective in different groups of patients. Coronary stents and implantable cardioverter-defibrillators are relatively new and expensive methods and only the latter have demonstrated a clear economic benefit. Because of the complex outcome, variables in septic patients’ full economic evaluations are difficult to perform. Currently, only one detailed cost analysis is available.