OBJECTIVES: To assess the cost-effectiveness of ivabradine for the treatment of chronic heart failure as an adjuvant to the standard therapy in patients with systolic dysfunction, NYHA class II to IV, with sinus rhythm, heart rate ≥ 75 bpm. The study was conducted in comparison with standard therapy alone, from the perspective of public health institutions in Mexico.

METHODS: A Markov model was developed with 8 health states. The model cycles were 3 months and the time horizon was 2 years, and extrapolated to 5 years. The costs of hospitalization and standard therapy were obtained from government sources. The transition probabilities to the 1^st hospitalization state and death state were obtained from the sub-analysis of SHIFT study (Böhm, y otros, 2013), second and third hospitalization states were taken from another sub-analysis (Borer, y otros, 2012) The main effectiveness outcome were life-years gained (LYG). incremental cost effectiveness ratio (ICER) per LYG was calculated to compare the treatments.

RESULTS: Over a 2-year time horizon, treatment with ivabradine plus standard therapy produced 1.78 LYG at a cost of $84,236.07, versus 1.69 LYG with standard therapy at a cost of $ 86,100.07. Thus, ivabradine plus standard therapy represents a saving of $1,864.00, therefore it is a dominant alternative.

Moreover, in a 5-year horizon, treatment with ivabradine plus standard therapy represents 3.23 LYG at a cost of $ 144,681.27, versus 2.78 LYG with standard therapy at a cost of $128,401.29. The ICER was $35,937 which means that ivabradine plus standard therapy is a cost-effective option.

CONCLUSIONS: This study demonstrated that ivabradine plus standard therapy is dominant over a 2-year horizon. Over a 5-year horizon, ivabradine plus standard therapy is a cost-effective option for public health institutions in Mexico.