BACKGROUND:
Atrial fibrillation (AF) in the setting of
heart failure (HF) is linked to
embolic stroke and exacerbation of HF. The rate of new-onset AF in patients with
left ventricular dysfunction and mild to moderate HF enrolled in the SoLVD trials was significantly lower with
enalapril than with
placebo (5.4% vs 24% over 2.9 years, P < .0001). The objective of this study was to predict economic benefits over 5 and 10 years of reduced AF incidence in patients receiving
enalapril for the treatment of HF from a Canadian third-party payer perspective. METHODS: Consequences of reduced incidence of AF in enalapril-treated patients were modeled using a
Markov model. Patients were assigned to 1 health state: no AF, AF, poststroke, or death, and moved from one state to the other according to published
incidence rates. It was assumed that most patients with AF would receive
warfarin for
stroke prevention. Resource use and costs were mostly retrieved from published Canadian studies. RESULTS: Reduced incidence of AF resulted in savings of 382 dollars and 525 dollars per patient treated with
enalapril over 5 and 10 years, respectively, which stemmed mainly from reduced AF hospitalization and less need for
warfarin and
amiodarone. Sensitivity analyses demonstrated that
enalapril becomes more cost saving as the baseline risk for
embolic stroke in patients with AF increases and the use of
warfarin prophylaxis decreases. CONCLUSIONS: Reduced incidence of AF with
enalapril leads to significant clinical and economic advantages on top of the already well-established benefits of
enalapril for patients with HF.
