PCV29: ECONOMIC OUTCOMES OF PATIENTS RECEIVING CARVEDILOL COMPARED TO THOSE RECEIVING NO BETA-BLOCKER THERAPY FOR THE TREATMENT OF CONGESTIVE HEART FAILURE IN A MANAGED CARE ORGANIZATION

Abstract

Considerable clinical trial data is available to support the use of beta-blockers for the treatment of congestive heart failure (CHF). OBJECTIVES: The primary objective is to compare differences in health care costs (pharmacy, medical, and total) between patients receiving carvedilol and those not receiving a beta-blocker for the treatment of CHF. The secondary objective is to determine differences among cohorts with respect to CHF-related costs and total health care costs (CHF and non-CHF related). METHODS: Retrospective claims data from a large managed care organization were analyzed. Patients were included if they had an ICD-9 diagnosis code for CHF between 1/1/97 and 12/31/99, received an ACE inhibitor and a diuretic, were continuously eligible, and at least 18 years old. The carvedilol group was newly started on carvedilol and did not receive another beta-blocker. The non beta-blocker group did not receive any beta-blockers and had no contraindications to beta-blocker therapy. All patients were followed for 1 year. Total health care costs include costs for all services covered. CHF-related costs include those directly related to the treatment of CHF. RESULTS: There were a total of 9,439 patients, 52.3% were female, and the average age was 77 (S.D. = 9.5) years. Total cost (CHF and non-CHF related) were measured after adjusting for age, gender, pre-total cost, and Charlson Comorbidity Index. Patients in the carvedilol group had higher pharmacy cost ($2,586 versus $1,343, P < .0001), lower medical cost ($18,196 versus $22,168, P = 0.362), and lower total cost ($20,782 versus $23,511, P = 0.619). When measuring only CHF-related costs, patients in the carvedilol group had higher pharmacy cost ($1,489 versus $416, P < .0001), lower medical cost ($2,232 versus $3,105, P = 0.450), and slightly higher total cost ($3,721 versus $3,521, P = 0.959). CONCLUSION: The higher pharmacy cost of carvedilol use appears to be offset by a reduction in total (CHF and non-CHF related) medical cost.