DOI: 10.1161/circ.148.suppl_1.15443 ISSN: 0009-7322

Abstract 15443: An Economic Modeling Analysis of an Intensive GDMT Optimization Program in Hospitalized Heart Failure Patients

Neal Dixit, Neil Parikh, Boback Ziaeian, Gregg C Fonarow
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Background For patients with heart failure with reduced ejection fraction (HFrEF), suboptimal initiation and titration of guideline-directed medical therapy (GDMT) has resulted in preventable loss of life and function. The STRONG-HF trial reinforced this finding by demonstrating substantial reductions in the composite of mortality and morbidity over 6 months among hospitalized heart failure (HF) patients who were randomized to intensive GDMT optimization compared to usual care. Research Question Whether an intensive GDMT optimization program would be cost-effective in HFrEF has yet to explored. Aim We performed an economic analysis of a hypothetical intensive GDMT optimization program over 6 months in patients hospitalized with HFrEF compared to usual care.

Methods: Using a 2-state Markov model we evaluated the effect of an intensive GDMT optimization program on patients hospitalized with HFrEF. Two population models were created to simulate this intervention, the first, a “clinical trial” model, based off the participants in the STRONG-HF trial and the second, a “real world” model, based off the Get With The Guidelines-HF Registry of patients admitted with worsening HF. We then modeled the effect of a 6-month intensive GDMT optimization program comprised of a HF physician, clinical pharmacists, and registered nurses. Hazard ratios from the intervention arm of the STRONG-HF trial were applied to both populations models to simulate clinical and financial outcomes of an intensive GDMT optimization program from a United States healthcare perspective with a lifetime time horizon.

Results: An intensive GDMT optimization program, resulted in an additional 1.04 and 0.59 life years in the clinical trial and real-world models, respectively. Both models showed the program would be highly cost-effective with incremental cost-effectiveness ratios <$5000 and reductions in healthcare spending due to reduced hospitalizations in the 6 months after discharge.

Conclusions: An intensive GDMT optimization program for patients hospitalized with HFrEF would be highly cost-effective and result in substantial gains in clinical outcomes. Clinicians, payers, and policy makers should prioritize creation of such programs.

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