There are approximately 300,000 Australians living with chronic heart failure, and approximately 30,000 new cases diagnosed each year. In Australia, chronic cardiovascular diseases are associated with health care costs of over five billion dollars, and estimates put the cost of heart failure at around one billion. The mortality, morbidity and health care costs of heart failure are considered significant. Despite the availability of strategies to treat and manage the disease, the disability and suffering associated with heart failure is devastating and indicates there is a large population with unmet health
Given the disability and suffering, and the large economic burden, it is reasonable to examine options that are not currently considered standard therapy in Australia. Research examining the use of complementary and alternative medicine, particularly the use of hawthorn extract is showing promising results.
A recent systematic review concluded hawthorn extract can provide significant benefits to heart failure patients as an adjunct to conventional treatment and a cost-effectiveness study from Germany concluded hawthorn is a cost-effective treatment option especially in the early stages of heart failure. Economic evaluation is a structured method for examining the costs and consequences involved with alternative methods of treatments and/or programs, in order to inform which is the best alternative from a particular viewpoint. The goal of such evaluation ultimately is to improve the use of health care resources and improve patient care.
An economic decision model was developed to examine the use of hawthorn as an adjunct to recommended treatment compared with recommended treatment from a health sector perspective. The four state Markov model of chronic heart failure was developed using the New York Heart Association (NYHA) classification system in Microsoft Excel®. Two versions of the model were constructed, one containing information regarding current recommended treatment and one with current recommended treatment and hawthorn extract as an adjunct to current treatment.
The results were plotted on a cost-effectiveness curve, using a threshold of $40,000, the new treatment has a 0.47 probability of being cost-effective.
The average incremental NMB with 95% credible intervals was -$580 (-$208 to -$952), the average NMB for the standard treatment was $90,989 ($89,916-$92,062), and for the new treatment $90,409.01 ($89,387-$91,430). The new intervention has a negative incremental net benefit, and would notcurrently offer good value for money for a health services decision maker.
The expected value of perfect information (EVPI) analysis showed that at a threshold of $40,000 per QALY, additional research is potentially cost-effective if research is not proposed to cost more than $390 million.
The partial EVPI (EVPPI) for each parameter/ parameter group was also examined. All parameters and parameter groups have significant EVPPI, but the impact varies. Utilities has the highest EVPPI ($279,202,295.01), and is the most important target for further research.
In terms of recommending one treatment over another, based on the results shown, the decision would be to recommend the standard treatment.
The results indicate further research is likely to be cost-effective, however, this would need to be reviewed in the context of the potential cost of further research. This will depend on the type of research that is needed, for example, randomised controlled trials will be more expensive than nonexperimental methods.
The partial value of perfect information analysis (EVPPI) showed the most important parameters for
further research was Utilities. Again the potential value of this research must be considered within the
context of the potential cost of this research.