Health economic consequences of the pharmacological treatment of heart failure.

Health economics is about spending limited resources wisely and, as with so many fields in medicine, combines science with art and ingenuity. In order to know whether money is well spent it is necessary to have some reference points to make comparisons. Many accepted cardiovascular interventions, such as revascularization for multivessel disease (US$50000 per life year gained) or the use of a statin for hypercholesterolaemia in middle-aged men at high risk of cardiovascular events (US$30000 per life year gained) are associated with moderate expense. By contrast heart failure is one of the few conditions in which, under some circumstances, lives may be saved while significantly reducing costs. This article seeks to review currently available reports on the health economic consequences of interventions for heart failure and describes the development of a new health economic model. Digoxin, ACE inhibitors and beta-blockers all appear to be cost-effective under widely differing sets of assumptions. Estimates range from a substantial cost-saving to a few thousand dollars per life year gained. The major factor limiting the reduction in costs associated with effective treatment for heart failure (with the exception of digoxin) is the costs incurred as a consequence of improved longevity. Money spent on treating heart failure well is money wisely spent.