PDF(Pubmed)
Abstract：
Heart failure (HF) poses a significant economic burden in the US, with costs projected to reach $70 billion by 2030. Cost-effectiveness analyses play a pivotal role in assessing the economic value of HF therapies. In this review, we overview the cost-effectiveness of HF therapies and discuss ways to improve patient access. Based on current costs, guideline directed medical therapies for HF with reduced ejection fraction provide high economic value except for sodium-glucose cotransporter-2 inhibitors, which provide intermediate economic value. Combining therapy with the four pillars of medical therapy also has intermediate economic value, with incremental cost-effectiveness ratios ranging from $73,000 to $98,500/ quality adjusted life-years. High economic value procedures include cardiac resynchronization devices, implantable cardioverter-defibrillators, and coronary artery bypass surgery. In contrast, advanced HF therapies have previously demonstrated intermediate to low economic value, but newer data appear more favorable. Given the affordability challenges of HF therapies, additional efforts are needed to ensure optimal care for patients. The recent Inflation Reduction Act contains provisions to reform policy pertaining to drug price negotiation and out-of-pocket spending, as well as measures to increase access to existing programs, including the Medicare low-income subsidy. On a patient level, it is also important to encourage patient and physician awareness and discussions surrounding medical costs. Overall, a broad approach to improving available therapies and access to care is needed to reduce the growing clinical and economic morbidity of HF.
摘要：
心力衰竭（HF）在美国造成了巨大的经济负担，预计到2030年，成本将达到700亿美元。成本效益分析在评估HF治疗的经济价值中起着关键作用。在这次审查中,我们概述了HF治疗的成本效益,并讨论了改善患者获得治疗的方法.根据当前成本，射血分数降低的HF的指导医学治疗提供了很高的经济价值，除了钠-葡萄糖协同转运蛋白-2抑制剂，提供中间经济价值。将治疗与药物治疗的四大支柱相结合也具有中等的经济价值，增量成本效益比从73,000美元到98,500美元/质量调整寿命年不等。高经济价值的程序包括心脏再同步装置，可植入心脏复律除颤器,冠状动脉搭桥手术.相比之下,先进的HF疗法以前已经证明了中等到低的经济价值，但较新的数据似乎更有利。鉴于HF治疗的可负担性挑战，需要额外的努力来确保对患者的最佳护理。最近的《降低通货膨胀法》包含有关药品价格谈判和自付支出的改革政策的规定，以及增加对现有计划的访问的措施，包括医疗保险低收入补贴。在病人层面上，同样重要的是鼓励患者和医生意识和围绕医疗费用的讨论.总的来说,需要采取广泛的方法来改善可用的治疗方法和获得治疗的机会,以降低HF的临床和经济发病率.
