RESUMO
OBJECTIVE: To evaluate the cost-benefit of using levosimendan compared with dobutamine, in the perioperative treatment of patients undergoing cardiac surgery who require inotropic support. METHODS: A two-part Markov model was designed to simulate health-state transitions of patients undergoing cardiac surgery, and estimate the short- and long-term health benefits of treatment. Hospital length of stay (LOS), mortality, medication, and adverse events were key clinical- and cost-inputs. Cost-benefits were evaluated in terms of costs and bed stays within the German healthcare system. Drug prices were calculated from the German Drug Directory (/2014) and published literature, with a 3% annual discount rate applied. The base case analysis was for a 1-year time horizon. RESULTS: The use of levosimendan vs dobutamine was associated with cost savings of 4787 per patient from the German hospital perspective due to reduced adverse events and shorter hospital LOS, leading to increased bed capacity and hospital revenue. LIMITATIONS: A pharmacoeconomic calculation for the specific situation of the German healthcare system that is based on international clinical trial carries a substantial risk of disregarding potentially relevant but unknown confounding factors (i.e., ICU-staffing, co-medications, standard-ICU care vs fast-tracking, etc.) that may either attenuate or increase the outcome pharmacoeconomic effects of a drug; however, since these conditions would also apply for patients treated with comparators, their net effects may not necessarily influence the conclusions. CONCLUSIONS: The use of levosimendan in patients undergoing cardiac surgery who require inotropic support appears to be cost-saving. The results of the analysis provide a strong rationale to run local clinical studies with pharmacoeconomic end-points which would allow a much more precise computation of the benefits of levosimendan.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiotônicos/economia , Cardiotônicos/uso terapêutico , Hidrazonas/economia , Hidrazonas/uso terapêutico , Piridazinas/economia , Piridazinas/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Cardiotônicos/administração & dosagem , Cardiotônicos/efeitos adversos , Análise Custo-Benefício , Dobutamina/economia , Dobutamina/uso terapêutico , Alemanha , Humanos , Hidrazonas/administração & dosagem , Hidrazonas/efeitos adversos , Seguro Saúde/economia , Tempo de Internação , Cadeias de Markov , Modelos Econométricos , Piridazinas/administração & dosagem , Piridazinas/efeitos adversos , SimendanaRESUMO
INTRODUCTION: Inodilators are the first-choice class of drugs for the treatment of acute heart failure (AHF). Levosimendan is a relatively recent inodilatory agent, presenting superior outcomes in comparison with traditional inotropes. METHODS: An economic evaluation of levosimendan for the treatment of AHF in Italy was performed. In a retrospective study conducted on patients with AHF admitted to a teaching hospital in Rome, two groups were derived from an observational registry: 147 patients treated with levosimendan and 145 treated with dobutamine. Follow-up was at 1 year after treatment. In the reference study looked at in this paper, treatment with levosimendan reduced mean length of stay (LOS) by 1.5 days (P<0.05). Reduction in the rehospitalization rate was 6.7% (P<0.05). Mortality rate at 1 month was reduced by 4.8% (P<0.05). RESULTS: Based on the reference study, a cost analysis from the hospital perspective was carried out. The incremental cost of treatment with levosimendan (697) was equivalent to the incremental savings (694), the latter being obtained from the reduction in LOS (508) and rehospitalization rate (186). CONCLUSION: Despite the limitations of this study, and even neglecting all nonmonetary health gains as additional outcomes, levosimendan appears to be a competitive alternative compared with dobutamine for the treatment of AHF in the Italian hospital setting.