OBJECTIVES: This study evaluated the cost-effectiveness of adding ivabradine, a HCN channel blocker in patients with HFrEF with resting heart rate ≥70 bpm despite being stabilized on optimal pharmacotherapy.

METHODS: A systematic review using the Pubmed/Medline was conducted to collect articles with relevance to the pharmacoeconomic aspects of ivabradine. The original search for “ivabradine” alone resulted in 1158 articles. To be more precise, we included MeSH search, (“ivabradine”[Supplementary Concept] AND “Heart Failure”[Mesh]) AND “Cost-Benefit Analysis”[Mesh], to retrieve relevant articles based on inclusion criteria: cost-effectiveness in the US and globally and limited to full text only. Out of 6 articles, 4 were relevant pharmacoeconomic studies. Additionally, a search with terms “ivabradine”, “heart failure”, “cost effectiveness” was conducted that resulted in 10 articles, of which one article was used. Finally, a total of 5 articles were included in this study.

RESULTS: All the studies in this pharmacoeconomic study showed cost-effectiveness with the addition of ivabradine to optimal drug therapy. The studies in this review used the Markov model for analysis, indicated a 10 year horizon and direct medical costs. In the United States, the addition of ivabradine resulted in total cost savings for the commercial population ($8594) and a modest cost increase in the Medicare Advantage population (+ $25,768) – offset by reduction in hospitalization cost ($20,855) and increased life-years (0.21). The cost-effectiveness ratio was $24,920/ QALY in the Medicare Advantage population and overall ICER ≤$50 000/QALY. Although the cost varied in each country, all studies had similar positive results.

CONCLUSIONS: It is recommended to add ivabradine to standard therapy in patients with CHF with resting heart rate ≥70 bpm based on the cost-effectiveness findings of this review. The financial burden can be expected to be substantially reduced overtime as cost would be offset by reduced morbidity, hospitalizations and improved health outcomes.