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Long-Term Cost-Effectiveness Analysis of Nebivolol Compared with Standard Care in Elderly Patients with Heart Failure

An Individual Patient-Based Simulation Model

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Abstract

Background and objective: The SENIORS trial demonstrated that nebivolol is effective in the treatment of heart failure in elderly patients (e.g. ≥70 years). This analysis evaluates the cost effectiveness of nebivolol compared with standard treatment.

Methods: An individual patient-simulation model based on a Markov modelling framework was developed to compare costs and outcomes for nebivolol and standard care in patients with heart failure starting treatment at the age of 70 years. Health states were defined by New York Heart Association (NYHA) class and death. At a given NYHA class and a given cycle, patients could die, be hospitalized for cardiovascular disease or remain stable. Risks for these events were derived from individual patient data from the SENIORS trial. The risk of each event in a given cycle was based on the subject’s baseline characteristics and time in the current health state.

The economic analysis was conducted from the UK NHS perspective with a lifetime horizon. The costs (€; year 2006 values) considered were drug costs for nebivolol and other cardiac drugs, costs of GP visits, outpatient specialist visits and cardiovascular-related hospitalizations. Univariate and probabilistic sensitivity analysis was conducted.

Results: In the baseline analysis, the total cost per patient was €6740 and €9288, and QALYs were 5.194 and 5.843 for patients aged 70 years at the start of treatment for the standard treatment and nebivolol groups, respectively. The probabilistic sensitivity analysis provided an incremental cost-effectiveness ratio of €3926 (95% CI 3731, 4159) per QALY.

Conclusions: This analysis indicates that nebivolol appears to be a cost-effective treatment for elderly patients with heart failure compared with standard care.

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Acknowledgements

The SENIORS study was sponsored by Menarini Research SpA, Florence, Italy, and the scientific conduct was managed by an independent Steering Committee. Menarini has made the data from the SENIORS study available for the present analysis, which was carried out independently in the Health Care Evaluation Group of the University of Birmingham. A grant for this work was provided by Menarini. The manuscript was reviewed by all authors and was provided to representatives from Menarini for comment in advance of submission for publication.

Guiqing Yao received funding from Menarini for conducting this research. Nick Freemantle has received funding for research, consulting and travel expenses from a number of companies manufacturing drugs and devices for heart failure. Marcus Flather holds a research grant from Menarini and has received speaker fees for presentations at meetings. He also holds research grants and has received speaker fees from the following companies: Astra Zeneca, GSK, sanofi-aventis, Bristol-Myers Squibb, CSL Behring, Eisai and Boehringer Ingelheim. He also holds consultancy contracts with EISAI, CSL Behring, sanofi-aventis and Bristol-Myers Squibb. Philip Poole-Wilson has received funding for research, consulting and travel expenses from companies with an interest in heart failure. He was a principal investigator for SENIORS and for COMET (Carvedilol Or Metoprolol European Trial), both trials relating to the use of β-blockers in heart failure. Andrew Coats has received funding for research, consulting and travel expenses from companies with an interest in heart failure. He was a principal investigator for SENIORS and for COPERNICUS (Carvedilol Prospective Randomized Cumulative Survival), both trials relating to the use of β-blockers in heart failure.

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Authors and Affiliations

  1. University of Birmingham, Birmingham, UK

    Guiqing Yao,  Nick Freemantle & Puvan Tharmanathan

  2. Royal Brompton and Harefield NHS Trust, London, UK

    Marcus Flather

  3. Imperial College of Science Technology and Medicine, London, UK

    Marcus Flather & Philip A. Poole-Wilson

  4. University of Sydney, Sydney, New South Wales, Australia

    Andrew Coats

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  1. Guiqing Yao
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  2. Nick Freemantle
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  5. Andrew Coats
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  6. Philip A. Poole-Wilson
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Correspondence to Nick Freemantle.

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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. Pharmacoeconomics 26, 879–889 (2008). https://doi.org/10.2165/00019053-200826100-00007

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