Costs and benefits of treatment for congestive heart failure

Congestive heart failure constitutes an important public health problem, because of its prevalence and mortality, and also its morbidity and significant resource utilization. It is the main cause of hospitalization for patients aged 65 or over, and it absorbs 2% of the health care budget in industrialized countries. With the aging of the population and the advancing age of the baby boom generation, the situation will worsen: the prevalence of congestive heart failure in Europe may increase by 70% by the year 2010. To favourably alter these economic consequences, treatment must not only prolong life but also slow down or even prevent disease progression towards more severe stages and decrease resource utilization, mainly in reducing the need for hospital admissions. To date, the most convincing results of economic analyses concern vasodilators: the hydralazine - isosorbide dinitrate combination and angiotensin converting enzyme inhibitors (ACE). Even if all these studies do not come to the same conclusions in terms of numbers, they agree in showing that costs per year of life saved by vasodilators, and particularly by ACE, are very favourable (<$ 10000 per year of life saved) and much lower than those of most other well accepted medical strategies.