The cost effectiveness and cost utility of XXXX in @entity712 therapy in Italy: a probabilistic markov model.

@entity917 @entity1 @entity712 @entity204
To evaluate the cost effectiveness and cost utility of the use of @entity917 in addition to standard therapy for the treatment of @entity1 with @entity712 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 ( @entity917 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 @entity204 ), and had a cycle duration of 1 month. Probabilistic simulations were performed using the WinBUGS software for Bayesian analysis. The distribution of @entity1 parameters (sex, age, use of beta-adrenoceptor antagonists, and ACE inhibitors) in the simulated population were derived from the Italian @entity712 @entity1 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 @entity712 hospitalizations. Quality-of-life (QOL) weights were obtained by using published health-related QOL data for @entity712 @entity1 . 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, @entity1 were estimated to live for an average of 2.3 years or 1.7 quality-adjusted life-years (QALYs), with slight increases in the @entity917 group. In this group, hospitalizations for worsening @entity712 were predicted to be significantly reduced and overall treatment costs per @entity1 to decrease by about and U20AC;550. In subgroup analyses, @entity917 lost dominance in @entity1 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. @entity917 in addition to standard therapy is predicted to dominate standard therapy alone in Italian @entity1 with mild to severe @entity712 and low LVEF. There are relevant differences among various @entity1 subgroups, and @entity917 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) @entity712 @entity1 .
