Economic Implications of Extended-Release Metoprolol Succinate for Heart Failure in the MERIT-HF Trial: A US Perspective of the MERIT-HF Trial

• Published in: Journal of cardiac failure 2005-12, Vol.11 (9), p.647-656
• Main Authors: Caro, J. Jamie, Migliaccio-Walle, Kristin, O'Brien, Judith A., Nova, William, Kim, Jennifer, Hauch, Ole, Hillson, Eric, Wedel, Hans, Hjalmarson, Åke, Gottlieb, Stephen, Deedwania, Prakash C., Wikstrand, John
• Format: Article
• Language: English
• Subjects: 80 and over; Adrenergic beta-Antagonists - administration & dosage; Adrenergic beta-Antagonists - economics; Adrenergic beta-Antagonists - therapeutic use; Adrenergic beta-Antagonists/administration & dosage/economics/therapeutic; Adult; Aged; Aged, 80 and over; Congestive/drug therapy/economics/mortality; Cost-Benefit Analysis; Costs; Delayed-Action Preparations; derivatives/economics/therapeutic use; Econometric; Female; Heart Failure; Heart Failure - drug therapy; Heart Failure - economics; Heart Failure - mortality; Hospital Costs; Hospital Mortality; Hospitalization; Hospitalization - economics; Hospitalization - statistics & numerical data; Hospitalization/economics/statistics & numerical data; Humans; Male; MEDICAL AND HEALTH SCIENCES; MEDICIN OCH HÄLSOVETENSKAP; MERIT-HF; Metoprolol - administration & dosage; Metoprolol - analogs & derivatives; Metoprolol - economics; Metoprolol - therapeutic use; Metoprolol/administration & dosage/analogs; Middle Aged; Models, Econometric; Prospective Studies; Randomized Controlled Trials; Randomized Controlled Trials as Topic; Reproducibility of Results; Survival Analysis; Treatment Outcome; United States; use
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2005.06.433

The MERIT-HF trial demonstrated improved survival and fewer hospitalizations for worsening heart failure with extended-release (ER) metoprolol succinate in patients with heart failure. This study sought to estimate the economic implications of this trial from a US perspective. A discrete event simulation was developed to examine the course of patients with heart failure. Characteristics of the population modeled, probabilities of hospitalization and death with standard therapy, and risk reductions with ER metoprolol succinate were obtained from Metoprolol CR/XL Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF) and evaluated in weekly cycles. Direct medical costs were estimated from US databases in 2001 US dollars. Uncertainty in inputs was incorporated and analyses were carried out to estimate events prevented total and net costs. The model predicts that ER metoprolol succinate will prevent approximately 7 deaths and 15 hospitalizations from heart failure per 100 patients over 2 years. Compared with standard therapy alone, this translates to a cost reduction between $395 and $1112 per patient, depending on whether the costs of hospitalizations for other causes are included. Savings were maintained in 90% of the simulations. This analysis predicts that the positive effect of ER metoprolol succinate on mortality and morbidity demonstrated in MERIT-HF leads to substantial savings.