Thursday, January 22, 2004

Beta-blockers Cost Effective for Heart Failure
By Mike Upchurch

A new study from the DCRI has found that beta-blockers, long given for blood pressure and irregular heart rhythms, also can be cost-effective in treating heart failure. The findings, published January 15 in the American Journal of Medicine, show that the medicines can save the healthcare system nearly $4000 per patient over 5 years of treatment.

Robert Califf, MD

According to the authors, beta-blocker therapy in heart failure would reduce per patient costs by $3959 over a 5-year course of treatment. Medicare costs would decline by over $6000 per patient, but the patient’s out-of-pocket expenses actually would rise by $2113 because of the lack of a prescription drug benefit. The prescription drug coverage recently passed by Congress will not take effect until 2006 and will still leave significant gaps in reimbursement for many patients.

"Our study suggests beta-blocker therapy is both clinically and financially beneficial over the long term from a societal standpoint," said Robert Califf, MD, lead researcher on the study and director of the DCRI. "The clinical benefit of beta-blockers is unquestioned. The issue here is that hospitals and physicians have no clear financial incentives to support increased beta blocker use. Changes in practice patterns could be encouraged, however, by linking reimbursement with evidenced-based care and covering patients' medication costs."

Using previous clinical studies to establish the effects of beta-blockers on heart failure, Dr. Califf and his co-authors developed a 5-year model of the disease and its treatment. They gathered treatment costs from the Duke University Medical Center system and based physician fees on Medicare rates. They then analyzed these numbers to paint an economic picture of beta-blocker use for patients, hospitals, physicians, the Medicare system, and society at large.

The study showed that expenditures for a heart failure patient not receiving beta-blockers during a 5-year period total $52,999 and survival typically is 3.6 years. Patients receiving beta-blockers have total costs of $49,040 and survive for 3.9 years. Most of the savings came from a decrease in inpatient costs, from $37,294 to $29,697, which translates to a savings of $7,597 per patient. Outpatient costs for patients receiving beta-blockers increased by $1,183, rising from $12,817 during the 5-year period to $14,000. Medication costs for those on beta-blockers increased by $2,455, rising from $2,888 to $5,343.

Between 500,000 and 750,000 new cases of heart failure are diagnosed and about 250,000 Americans die from the disease each year. The total annual costs of treating the disease in the U.S. exceed $6 billion. As more and more heart failure patients survive longer because of improved medical care and better medicines, these costs promise to rise even further.

Beta-blockers offer a way of reducing total expenses without compromising patient care. According to Dr. Califf, a wealth of clinical data shows the benefits of beta-blocker therapy in heart failure, but less than 50% of eligible heart failure patients receive it.

The researchers noted that physician and hospital revenues would decrease with broader use of beta-blockers because fewer patients would need to be readmitted to the hospital once discharged on the drugs. Instead, physicians will be called upon to spend more time on symptom management for patients who survive longer and longer with heart failure.

"Hospitals have no financial incentive to reduce heart failure readmissions if these admissions generate at least as much net revenue as other hospitalizations. In this situation, providing reimbursement for improved discharge prescribing patterns could motivate hospitals to encourage physicians to optimize discharge medications," Califf said.

"Without additional resources, physicians may not be able to alter their practice patterns in a way that increases the demands on their time brought about by broader beta-blocker usage. Additional funding for outpatient management, such as coverage of clinical pharmacist services, could remove financial barriers to improving prescribing patterns," he added.

The study was conducted by the Duke Centers for Education & Research on Therapeutics (CERTs). CERTs is a federally sponsored network of private and public research centers that seek ways to improve the safe, effective use of new or existing medical therapies. CERTs is coordinated by the DCRI and administered by the Agency for Healthcare Research and Quality.

Joining Dr. Califf from the DCRI were: Patricia Cowper, PhD; Elizabeth DeLong, PhD; David Whellan, MD; and Nancy Allen LaPointe, PharmD.