OBJECTIVES: To assess the health economic evidence of chronic heart failure (CHF) treatments through a targeted literature review.

METHODS: A literature search was conducted in EMBASE, MEDLINE, EconLit, NHS EED and Health Technology Assessment databases. Modelling studies assessing the cost-effectiveness of pharmacological treatment and medical devices in CHF were included (Limits: 2011-2021 and English language).

RESULTS: A total of 22 studies assessing unique models in CHF were included. Eighteen studies assessed the cost-effectiveness of pharmacological treatments: sacubitril/valsartan (n=8), dapagliflozin (n=5), empagliflozin (n=1), ivabradine (n=3), and vericiguat (n=1); and four studies assessed cost-effectiveness of medical devices (one study each of implantable cardioverter defibrillator [ICD] / cardiac resynchronization therapy pacemakers [CRT-P], cardiac resynchronization therapy defibrillator [CRT-D], Baroreflex activation therapy [BAT], and Cardiac contractility modulation [CCM]). Markov models were the most common modelling technique (n=18), followed by risk equations (n=4). Eight studies categorized patients based on the New York heart association (NYHA) classification, ten studies did not use any patient categorization, and four studies used other disease classifications. Compared to standard of care, all active treatments were reported as cost-effective, except in one study, ICD, CRT-P and CRT-D were found to be cost-effective only in specific patient sub-groups. Across the studies, relative-risk for hospitalization and death, cost of treatment, utility values, time horizon and age of patients were identified as key model drivers.

CONCLUSIONS: Results of our review can be useful for physicians and other decision-makers to prescribe appropriate treatments for CHF. Evidence on the cost-effectiveness of medical devices is limited, suggesting an unmet need for an appropriate and economic treatment option in patients uncontrolled on pharmacological therapy.