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COST-EFFECTIVENESS ANALYSIS OF IVABRADINE IN TREATMENT OF PATIENTS WITH HEART FAILURE IN IRAN

Published online by Cambridge University Press:  18 December 2018

Saeed Taheri ,
Elham Heidari ,
Mohammad Ali Aivazi ,
Mehran Shams-Beyranvand  and
Mehdi Varmaghani Open the ORCID record for Mehdi Varmaghani [Opens in a new window]
Saeed Taheri
Affiliation:
Department of pharmacoeconomics and pharma management, School of pharmacy, Shahid Beheshti university of medical scienceStudents' research committee, Shahid Beheshti university of medical science
Elham Heidari
Affiliation:
Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences
Mohammad Ali Aivazi
Affiliation:
Department of pharmacoeconomics and pharma management, School of pharmacy, Shahid Beheshti university of medical science
Mehran Shams-Beyranvand
Affiliation:
Dezful University of Medical Sciences,Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences
Mehdi Varmaghani
Affiliation:
Social Determinants of Health Research Center, Mashhad University of Medical Sciences Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciencesvarmaghanim@mums.ac.ir
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Abstract

Objectives:

This study aimed to assess the cost-effectiveness of ivabradine plus standard of care (SoC) in comparison with current SoC alone from the Iranian payer perspective.

Methods:

A cohort-based Markov model was developed to assess the incremental cost-effectiveness ratio (ICER) over a 10-year time horizon in a cohort of 1,000 patients. The baseline transition probabilities between New York Heart Association (NYHA), mortality rate, and hospitalization rate were extracted from the literature. The effect of ivabradine on mortality, hospitalization, and NYHA improvement or worsening were retrieved from the SHIFT study. The effectiveness was measured as quality-adjusted life-years (QALYs) using the utility values derived from Iranian Heart Failure Quality of Life study. Direct medical costs were obtained from hospital records and national tariffs. Deterministic and probabilistic sensitivity analyses were conducted to show the robustness of the model.

Results:

Ivabradine therapy was associated with an incremental cost per QALY of USD $5,437 (incremental cost of USD $2,207 and QALYs gained 0.41) versus SoC. The probabilistic sensitivity analysis showed that ivabradine is expected to have a 60 percent chance of being cost-effective accepting a threshold of USD $6,550 per QALY. Furthermore, deterministic sensitivity analysis indicated that the model is sensitive to the ivabradine drug acquisition cost.

Conclusions:

The cost-effectiveness model suggested that the addition of ivabradine to SoC therapy was associated with improved clinical outcomes along with increased costs. The analysis indicates that the clinical benefit of ivabradine can be achieved at a reasonable cost in eligible heart failure patients with sinus rhythm and a baseline heart rate ≥ 75 beats per minute (bpm).

Keywords

IvabradineHeart failureIranCost-effectiveness analysis
Type
Assessment
Information
International Journal of Technology Assessment in Health Care , Volume 34 , Issue 6 , 2018 , pp. 576 - 583
Copyright
Copyright © Cambridge University Press 2018 

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Footnotes

This study is the outcome of a study approved by students’ research committee of Shahid Beheshti University of Medical Sciences. This work was supported by the Rougine Darou Corporation. S.T. and M.A.A. were paid consultants to Rougine Darou Corp. For the purposes of this project M.V., E.H., and M.Sh. have disclosed that they have no relevant financial relationships. Conflict of interest: None. The authors thank Daniel Hurlbut for proofreading the article.

References

REFERENCES

1.Heart Failure - Heart Conditions - British Heart Foundation [Internet]. [cited Sepember 3, 2017]. https://www.bhf.org.uk/heart-health/conditions/heart-failure (accessed November 10, 2018).Google Scholar
2.Mosterd, A, Hoes, AW. Clinical epidemiology of heart failure. Heart. 2007;93:1137-1146.Google Scholar
3.Marvin, HM. Diseases of the heart and blood vessels: Nomenclature and criteria for diagnosis. Arch Intern Med. 1964;113:906.Google Scholar
4.Braunschweig, F, Cowie, MR, Auricchio, A. What are the costs of heart failure? Europace. 2011;Suppl 2:ii13-ii17.Google Scholar
5.Ponikowski, P, Anker, SD, AlHabib, KF, et al. Heart failure: Preventing disease and death worldwide. ESC Hear Fail. 2014;1:4-25.Google Scholar
6.Bui, AL, Horwich, TB, Fonarow, GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011;8:30-41.Google Scholar
7.Hekmatpou, D, Mohammadi, E, Ahmadi, F, Arefi, SH. Termination of professional responsibility: Exploring the process of discharging patients with heart failure from hospitals. Int J Nurs Pract. 2010;16:389-396.Google Scholar
8.Callender, T, Woodward, M, Roth, G, et al. Heart failure care in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med. 2014;11:e1001699.Google Scholar
9.Cowie, MR, Wood, DA, Coats, AJ, et al. Survival of patients with a new diagnosis of heart failure: A population based study. Heart. 2000;83:505-510.Google Scholar
10.Go, AS, Mozaffarian, D, Roger, VL, et al. Heart disease and stroke statistics--2014 update: A report from the American Heart Association. Circulation. 2014;129:e28-e29.Google Scholar
11.Kaye, DM, Krum, H. Drug discovery for heart failure: A new era or the end of the pipeline? Nat Rev Drug Discov. 2007;6:127-139.Google Scholar
12.Swedberg, K, Komajda, M, Böhm, M, et al. Ivabradine and outcomes in chronic heart failure (SHIFT): A randomised placebo-controlled study. Lancet. 2010;376:875-885.Google Scholar
13.Kansal, AR, Cowie, MR, Kielhorn, A, et al. Cost-effectiveness of Ivabradine for heart failure in the United States. J Am Heart Assoc. 2016;5. pii:e003221.Google Scholar
14.Griffiths, A, Paracha, N, Davies, A, et al. The cost effectiveness of ivabradine in the treatment of chronic heart failure from the UK National Health Service perspective. Heart. 2014;100:1031-1036.Google Scholar
15.Iliza, AC, Matteau, A, Guertin, JR, et al. A model to assess the cost-effectiveness of pharmacogenomics tests in chronic heart failure: The case of ivabradine. Pharmacogenomics. 2016;17:1693-1706.Google Scholar
16.Kourlaba, G, Parissis, J, Karavidas, A, et al. Economic evaluation of ivabradine in the treatment of chronic heart failure in Greece. BMC Health Serv Res. 2014;14:631.Google Scholar
17.Yao, G, Freemantle, N, Flather, M, et al. Long-term cost-effectiveness analysis of nebivolol compared with standard care in elderly patients with heart failure: An individual patient-based simulation model. Pharmacoeconomics. 2008;26:879-889.Google Scholar
18.I.R. Iran GDP per capita (current US$) [Internet]. The World Bank. [cited January 12, 2016]. http://data.worldbank.org/indicator/NY.GDP.PCAP.CD/countries/IR (accessed November 10, 2018).Google Scholar
19.WHO | Table: Threshold values for intervention cost-effectiveness by region. Geneva: World Health Organization; 2014.Google Scholar
20.Abdoli, G. Estimation of social discount rate for Iran. Econ Res Rev. 2009;10:135-156.Google Scholar
21.Robberstad, B. Estimation of private and social time preferences for health in northern Tanzania. Soc Sci Med. 2005;61:1597-1607.Google Scholar
22.Ahmed, A, Aronow, WS, Fleg, JL. Higher New York Heart Association classes and increased mortality and hospitalization in patients with heart failure and preserved left ventricular function. Am Heart J. 2006;151:444-450.Google Scholar
23.Borer, JS, Böhm, M, Ford, I, et al. Effect of ivabradine on recurrent hospitalization for worsening heart failure in patients with chronic systolic heart failure: The SHIFT Study. Eur Heart J. 2012;33:2813-2820.Google Scholar
24.Muntwyler, J, Abetel, G, Gruner, C, Follath, F. One-year mortality among unselected outpatients with heart failure. Eur Heart J. 2002;23:1861-1866.Google Scholar
25.NICE. The National Institute for Health and Care Excellence. Single Technology Appraisal (STA) Specification for manufacturer/sponsor submission of evidence. Ivabradine for the treatment of chronic heart failure. London: NICE; 2012.Google Scholar
26.Griffiths, A, Paracha, N, Davies, A, Branscombe, N, Cowie, MR, Sculpher, M. The cost effectiveness of ivabradine in the treatment of chronic heart failure from the UK National Health Service perspective. Heart. 2014;(August):1–6. doi:10.1136/heartjnl-2013-304598Google Scholar
27.Ford, E, Adams, J, Graves, N. Development of an economic model to assess the cost-effectiveness of hawthorn extract as an adjunct treatment for heart failure in Australia. BMJ Open. 2012;2:e001094.Google Scholar
28.Edwards, SJ, Barton, S, Nherera, L, Trevor, N, Hamilton, V. Ivabradine for the treatment of chronic heart failure: A single technology appraisal. https://www.nice.org.uk/guidance/ta267/documents/heart-failure-chronic-ivabradine-evidence-review-group-report2 (accessed November 10, 2018).Google Scholar
29.Naderi, N, Bakhshandeh, H, Amin, A, et al. Development and validation of the first Iranian questionnaire to assess quality of life in patients with heart failure: IHF-QoL. Res Cardiovasc Med. 2012;1:10-16.Google Scholar
30.Griffiths, A, Paracha, N, Davies, A, et al. Analysing health-related quality of life data to estimate parameters for cost-effectiveness models: An example using longitudinal EQ-5D data from the SHIFT randomised controlled trial. Adv Ther. 2017;34:753-764.Google Scholar
31.Fernandez de, BJ, Gonzalez, FO, Lopez de, SE, Lopez-Sendon, JL. Cost-effectiveness analysis of ivabradine in heart failure with reduced left ventricular ejection fraction in Spain. Value Healh. 2014;17:A486.Google Scholar
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