Int J Technol Assess Health Care. 2018;34(6):576-583. doi: 10.1017/S0266462318003598. Epub 2018 Dec 18.
COST-EFFECTIVENESS ANALYSIS OF IVABRADINE IN TREATMENT OF PATIENTS WITH HEART FAILURE IN IRAN.
International journal of technology assessment in health care
Saeed Taheri, Elham Heidari, Mohammad Ali Aivazi, Mehran Shams-Beyranvand, Mehdi Varmaghani
Affiliations
Affiliations
- Department of pharmacoeconomics and pharma management, School of pharmacy, Shahid Beheshti university of medical scienceStudents' research committee, Shahid Beheshti university of medical science.
- Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences.
- Department of pharmacoeconomics and pharma management, School of pharmacy, Shahid Beheshti university of medical science.
- Dezful University of Medical Sciences,Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences.
- 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 [email protected].
PMID: 30560749
DOI: 10.1017/S0266462318003598
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: Cost-effectiveness analysis; Heart failure; Iran; Ivabradine
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