PMID- 19929036
OWN - NLM
STAT- MEDLINE
DCOM- 20100315
LR  - 20151119
IS  - 1175-3277 (Print)
IS  - 1175-3277 (Linking)
VI  - 9
IP  - 6
DP  - 2009
TI  - The cost effectiveness and cost utility of valsartan in chronic heart failure 
      therapy in Italy: a probabilistic markov model.
PG  - 383-92
LID - 10.2165/11315730-000000000-00000 [doi]
AB  - To evaluate the cost effectiveness and cost utility of the use of valsartan in 
      addition to standard therapy for the treatment of patients with chronic heart 
      failure with low left ventricular ejection fraction (LVEF). The study was 
      conducted by means of a cohort simulation based on a probabilistic Markov model 
      and projecting the 23-month follow-up results of the Val-HeFT (Valsartan Heart 
      Failure Trial) study over a 10-year time horizon. The model included four states 
      (New York Heart Association [NYHA] classes II, III, IV, and death), and had a 
      cycle duration of 1 month. Probabilistic simulations were performed using the 
      WinBUGS software for Bayesian analysis. The distribution of patient parameters 
      (sex, age, use of beta-adrenoceptor antagonists, and ACE inhibitors) in the 
      simulated population were derived from the Italian heart failure patient 
      population. Individual mortality data were derived from general mortality data by 
      multiplying by a NYHA state-specific relative risk, while the probability of 
      changing NYHA class was taken from the Val-HeFT data. Costs (2007 values) were 
      calculated from the perspective of the Italian Health Service (IHS) and included 
      costs for drugs and heart failure hospitalizations. Quality-of-life (QOL) weights 
      were obtained by using published health-related QOL data for heart failure 
      patients. A 3.5% annual discount rate was applied. Probabilistic sensitivity 
      analysis was performed on each parameter using original-source 95% confidence 
      interval (CI) values, or a +/-10% range when 95% CI values were unavailable. For 
      the 10-year time horizon, patients were estimated to live for an average of 2.3 
      years or 1.7 quality-adjusted life-years (QALYs), with slight increases in the 
      valsartan group. In this group, hospitalizations for worsening heart failure were 
      predicted to be significantly reduced and overall treatment costs per patient to 
      decrease by about and U20AC;550. In subgroup analyses, valsartan lost dominance 
      in patients in NYHA II, and in those receiving beta-adrenoceptor antagonists or 
      ACE inhibitors; the mean incremental cost-utility ratio for these groups was 21 
      240, 129 200, and 36 500 and U20AC;/QALY, respectively. Valsartan in addition to 
      standard therapy is predicted to dominate standard therapy alone in Italian 
      patients with mild to severe heart failure and low LVEF. There are relevant 
      differences among various patient subgroups, and valsartan is expected to be good 
      value for money particularly in the treatment of the most severe and less 
      intensively treated (no ACE inhibitors, no beta-adrenoceptor antagonist) heart 
      failure patients.
FAU - Pradelli, Lorenzo
AU  - Pradelli L
AD  - AdRes Srl, Turin, Italy. l.pradelli@adreshe.com
FAU - Iannazzo, Sergio
AU  - Iannazzo S
FAU - Zaniolo, Orietta
AU  - Zaniolo O
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - New Zealand
TA  - Am J Cardiovasc Drugs
JT  - American journal of cardiovascular drugs : drugs, devices, and other 
      interventions
JID - 100967755
RN  - 0 (Antihypertensive Agents)
RN  - 0 (Tetrazoles)
RN  - 80M03YXJ7I (Valsartan)
RN  - HG18B9YRS7 (Valine)
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Antihypertensive Agents/*economics/therapeutic use
MH  - Chronic Disease/drug therapy/economics
MH  - Computer Simulation
MH  - Cost-Benefit Analysis/*methods
MH  - Drug Costs
MH  - Female
MH  - Heart Failure/*drug therapy/*economics/mortality
MH  - Hospital Costs
MH  - Humans
MH  - Italy
MH  - Male
MH  - *Markov Chains
MH  - Middle Aged
MH  - Models, Statistical
MH  - Quality of Life
MH  - Quality-Adjusted Life Years
MH  - Sex Factors
MH  - Tetrazoles/*economics/therapeutic use
MH  - Valine/*analogs & derivatives/economics/therapeutic use
MH  - Valsartan
EDAT- 2009/11/26 06:00
MHDA- 2010/03/17 06:00
CRDT- 2009/11/26 06:00
PHST- 2009/11/26 06:00 [entrez]
PHST- 2009/11/26 06:00 [pubmed]
PHST- 2010/03/17 06:00 [medline]
AID - 4 [pii]
AID - 10.2165/11315730-000000000-00000 [doi]
PST - ppublish
SO  - Am J Cardiovasc Drugs. 2009;9(6):383-92. doi: 10.2165/11315730-000000000-00000.