PMID- 32710439 OWN - NLM STAT- MEDLINE DCOM- 20211026 LR - 20211204 IS - 1179-187X (Electronic) IS - 1175-3277 (Linking) VI - 21 IP - 2 DP - 2021 Mar TI - Ex Ante Economic Evaluation of Arg389 Genetically Targeted Treatment with Bucindolol versus Empirical Treatment with Carvedilol in NYHA III/IV Heart Failure. PG - 205-217 LID - 10.1007/s40256-020-00425-x [doi] AB - OBJECTIVE: The Beta-Blocker Evaluation Survival Trial showed no survival benefit for bucindolol in New York Heart Association (NYHA) class III/IV heart failure (HF) with reduced ejection fraction, but subanalyses suggested survival benefits for non-Black subjects and Arg389 homozygotes. We conducted an ex ante economic evaluation of Arg389 targeted treatment with bucindolol versus carvidolol, complementing a previous ex ante economic evaluation of bucindolol preceded by genetic testing for the Arg389 polymorphism, in which genetic testing prevailed economically over no testing. METHODS: A decision tree analysis with an 18-month time horizon was performed to estimate the cost effectiveness/cost utility of trajectories of 100%, 50%, and 0% of patients genetically tested for Arg389 and comparing bucindolol with empirical carvedilol treatment as per prior BEST subanalyses. Incremental cost-effectiveness/cost-utility ratios (ICERs/ICURs) were estimated. RESULTS: Race-based analyses for non-White subjects at 100% testing showed a loss of (0.04) life-years and (0.03) quality-adjusted life-years (QALYs) at an incremental cost of $2185, yielding a negative ICER of ($54,625)/life-year and ICUR of ($72,833)/QALY lost; at 50%, the analyses showed a loss of (0.27) life-years and (0.16) QALYs at an incremental cost of $1843, yielding a negative ICER of ($6826)/life-year and ICUR of ($11,519)/QALY lost; at 0%, the analyses showed a loss of (0.33) life-years and (0.30) QALYs at an incremental cost of $1459, yielding a negative ICER of ($4421)/life-year and ICUR of ($4863)/QALY lost. Arg389 homozygote analyses at 100% testing showed incremental gains of 0.02 life-years and 0.02 QALYs at an incremental cost of $378, yielding an ICER of 18,900/life-year and ICUR of $18,900/QALY gained; at 50%, the analyses showed a loss of (0.24) life-years and (0.09) QALYs at an incremental cost of $1039, yielding a negative ICER of ($4329)/life-year and ICUR of ($9336)/QALY lost; at 0%, the analyses showed a loss of (0.33) life-years and (0.30) QALYs at an incremental cost of $1459, yielding a negative ICER of ($4421)/life-year and ICUR of ($4863)/QALY lost. CONCLUSION: This independent ex ante economic evaluation suggests that genetically targeted treatment with bucindolol is unlikely to yield clinicoeconomic benefits over empirical treatment with carvedilol in NYHA III/IV HF. FAU - Alkhatib, Nimer AU - Alkhatib N AUID- ORCID: 0000-0001-5071-9257 AD - Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Drachman Hall B-306, 1295 N. Martin Ave, Tucson, AZ, 85721, USA. AD - College of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan. FAU - Sweitzer, Nancy K AU - Sweitzer NK AD - Sarver Heart Center, University of Arizona, Tucson, AZ, USA. AD - College of Medicine, University of Arizona, Tucson, AZ, USA. FAU - Lee, Christopher S AU - Lee CS AD - Connell School of Nursing, Boston College, Chestnut Hill, MA, USA. FAU - Erstad, Brian AU - Erstad B AD - Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Drachman Hall B-306, 1295 N. Martin Ave, Tucson, AZ, 85721, USA. AD - Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA. FAU - Slack, Marion AU - Slack M AD - Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Drachman Hall B-306, 1295 N. Martin Ave, Tucson, AZ, 85721, USA. AD - Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA. FAU - Gharaibeh, Mahdi AU - Gharaibeh M AD - Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Drachman Hall B-306, 1295 N. Martin Ave, Tucson, AZ, 85721, USA. FAU - Karnes, Jason AU - Karnes J AD - Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA. FAU - Klimecki, Walter AU - Klimecki W AD - Department of Pharmacology and Toxicology, College of Pharmacy, University of Arizona, Tucson, AZ, USA. FAU - Ramos, Kenneth AU - Ramos K AD - College of Medicine, University of Arizona, Tucson, AZ, USA. AD - Institute of BioSciences and Technology, Texas A&M University, Houston, TX, USA. FAU - Abraham, Ivo AU - Abraham I AUID- ORCID: 0000-0003-0490-4421 AD - Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Drachman Hall B-306, 1295 N. Martin Ave, Tucson, AZ, 85721, USA. abraham@pharmacy.arizona.edu. AD - College of Medicine, University of Arizona, Tucson, AZ, USA. abraham@pharmacy.arizona.edu. AD - Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA. abraham@pharmacy.arizona.edu. LA - eng PT - Journal Article 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 (Propanolamines) RN - 0 (Receptors, Adrenergic, beta-1) RN - 0K47UL67F2 (Carvedilol) RN - E9UO06K7CE (bucindolol) SB - IM MH - Antihypertensive Agents/adverse effects/economics/*therapeutic use MH - Carvedilol/adverse effects/economics/*therapeutic use MH - Cost-Benefit Analysis MH - Decision Trees MH - Health Expenditures MH - Health Services/economics/statistics & numerical data MH - Heart Failure/*drug therapy/*genetics/mortality MH - Hospitalization/economics MH - Humans MH - Models, Econometric MH - Patient Acceptance of Health Care/statistics & numerical data MH - Polymorphism, Single Nucleotide MH - Propanolamines/adverse effects/economics/*therapeutic use MH - Quality-Adjusted Life Years MH - Racial Groups/genetics MH - Receptors, Adrenergic, beta-1/*genetics MH - Stroke Volume MH - Trauma Severity Indices EDAT- 2020/07/28 06:00 MHDA- 2021/10/27 06:00 CRDT- 2020/07/26 06:00 PHST- 2020/07/28 06:00 [pubmed] PHST- 2021/10/27 06:00 [medline] PHST- 2020/07/26 06:00 [entrez] AID - 10.1007/s40256-020-00425-x [pii] AID - 10.1007/s40256-020-00425-x [doi] PST - ppublish SO - Am J Cardiovasc Drugs. 2021 Mar;21(2):205-217. doi: 10.1007/s40256-020-00425-x.