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(Circulation. 2005;112:3745-3753.)
© 2005 American Heart Association, Inc.

Heart Failure

Cost-Effectiveness of Fixed-Dose Combination of Isosorbide Dinitrate and Hydralazine Therapy for Blacks With Heart Failure

Derek C. Angus, MD, MPH; Walter T. Linde-Zwirble; S. William Tam, PhD; Jalal K. Ghali, MD; Michael L. Sabolinski, MD; Victor G. Villagra, MD; Wolfgang C. Winkelmayer, MD, ScD; Manuel Worcel, MD, for the African-American Heart Failure Trial (A-HeFT) Investigators

From CRISMA Laboratory (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pa (D.C.A.); ZD Associates, Perkasie, Pa (W.T.L.-Z.); NitroMed, Inc, Lexington, Mass (S.W.T., M.L.S., M.W.); Louisiana State University Health Sciences Center, Shreveport (J.K.G.); Health and Technology Vector, Inc, Farmington, Conn (V.G.V.); and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Mass (W.C.W.).

Correspondence to Derek C. Angus, MD, MPH, 604 Scaife Hall, Critical Care Medicine, University of Pittsburgh, 3550 Terrace St, Pittsburgh, PA 15261. E-mail angusdc{at}upmc.edu

Received May 23, 2005; revision received September 14, 2005; accepted September 16, 2005.

Background— Fixed-dose combination of isosorbide dinitrate/hydralazine (ISDN/HYD) improved clinical outcomes in the African-American Heart Failure Trial (A-HeFT). We assessed the resource use, costs of care, and cost-effectiveness of ISDN/HYD therapy in the A-HeFT trial population.

Methods and Results— We obtained resource use data from A-HeFT, assigning costs through the use of US federal sources. Excluding indirect costs, we summarized the within-trial experience and modeled cost-effectiveness over extended time horizons, including a US societal lifetime reference case. During the mean trial follow-up of 12.8 months, the ISDN/HYD group incurred fewer heart failure–related hospitalizations (0.33 versus 0.47 per subject; P=0.002) and shorter mean hospital stays (6.7 versus 7.9 days; P=0.006). When study drug costs were excluded, both heart failure–related and total healthcare costs were lower in the ISDN/HYD group (mean per-subject heart failure–related costs, $5997 versus $9144; P=0.04; mean per-subject total healthcare costs, $15 384 versus $19 728; P=0.03). With an average daily drug cost of $6.38, ISDN/HYD therapy was dominant (reduced costs and improved outcomes) over the trial duration. Assuming that no additional benefits accrue beyond the trial, we project the cost-effectiveness of ISDN/HYD therapy using heart failure–related costs to be $16 600/life-year at 2 years after enrollment, $37 100/life-year at 5 years, and $41 800/life-year over lifetime (reference case).

Conclusions— ISDN/HYD therapy, previously shown to improve clinical outcomes, also reduced resource use and costs in A-HeFT, primarily because of a large reduction in hospitalizations. Long-term use of ISDN/HYD therapy should be associated with a favorable cost-effectiveness profile in this population.

Key Words: cardiovascular diseases • cost-benefit analysis • heart failure • nitric oxide • vasodilation

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