Cost-effectiveness analysis in clinical practice: the case of heart failure

Arch Intern Med. 1999 Aug;159(15):1690-700. doi: 10.1001/archinte.159.15.1690.


Heart failure is the leading cause of hospitalization in adults older than 65 years, and it is currently the most costly cardiovascular disorder in the United States, with estimated annual expenditures in excess of $20 billion. Recent studies have shown that selected pharmacological agents, behavioral interventions, and surgical therapies are associated with improved clinical outcomes in patients with heart failure, but the cost implications of these diverse treatment modalities are not widely appreciated. In this review, a brief outline of cost-effectiveness analysis is provided, and current data on the cost-effectiveness of specific approaches to managing heart failure are discussed. Available evidence indicates that angiotensin converting enzyme inhibitors, other vasodilators, digoxin, carvedilol, multidisciplinary heart failure management teams, and heart transplantation are all cost-effective approaches to treating heart failure; moreover, some of these interventions may result in net cost savings.

Publication types

  • Review

MeSH terms

  • Angiotensin-Converting Enzyme Inhibitors / economics
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Clinical Medicine / economics*
  • Combined Modality Therapy
  • Confounding Factors, Epidemiologic
  • Cost-Benefit Analysis*
  • Heart Failure / drug therapy
  • Heart Failure / economics*
  • Heart Failure / surgery
  • Heart Failure / therapy*
  • Heart Transplantation / economics
  • Hospital Charges
  • Humans
  • Patient Care Team
  • United States


  • Angiotensin-Converting Enzyme Inhibitors