OBJECTIVES: Ivabradine is a heart rate-lowering agent approved to reduce the risk of hospitalization in chronic heart failure (CHF) patients with sinus rhythm and a baseline heart rate ≥ 75 bpm. The aim of this study was to assess the cost-effectiveness of Ivabradine plus standard care (SoC) in comparison with current SoC alone from the perspective of Iranian healthcare system.

METHODS: A cost-effectiveness, cohort-based Markov model were developed using the Microsoft Excel to assess the incremental cost-effectiveness ratio (ICER) over a 10-year time horizon in a cohort of 1000 patients. All clinical inputs of the model (i.e. mortality rates, hospitalization rates, NYHA class distribution, adverse events) were estimated from SHIFT randomized clinical trial data. The effectiveness were measured as Quality-adjusted life years (QALYs) using the utility values derived from Iranian HF-QoL study. Direct medical costs were obtained from hospital records and national tariffs. Deterministic and probabilistic sensitivity analysis were conducted to show the robustness of the model over the uncertainty of key parameters.

RESULTS: Ivabradine therapy would be associated with an incremental cost per QALY of $6,060 (incremental cost of $2175 and QALYs gained 0.36) versus SoC over a 10-year time horizon. The probabilistic sensitivity analysis showed that Ivabradine is expected to have a 58% chance of being cost-effective accepting a threshold of $6,500 per QALY. Furthermore, deterministic sensitivity analysis indicated that the model is most sensitive to the Ivabradin drug acquisition cost.

CONCLUSIONS: The cost-effectiveness model suggests that, the addition of Ivabradine to SoC therapy was associated with improved clinical outcomes and also increased costs. From an Iranian healthcare system, the analysis indicates that the clinical benefit of Ivabradine can be achieved at a reasonable cost in eligible CHF patients with sinus rhythm and a baseline heart rate ≥ 75 bpm.