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

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.