What is the economic value of digoxin therapy in congestive heart failure patients? Results from the DIG trial

J Card Fail. 2006 Jun;12(5):336-42. doi: 10.1016/j.cardfail.2006.04.002.


Background: The Digitalis Investigation Group (DIG) clinical train randomized 6800 congestive heart failure patients (ejection fraction > or =45%) to a daily regimen of either digoxin or placebo. At 37 months average follow-up, patients in both groups had similar mortality. We determined the incremental costs associated with the use of digoxin in this high-risk population.

Methods and results: Hospitalizations and medical costs were compared by using a societal perspective. Hospitalizations were assigned Medicare DRG codes by using descriptive information from the clinical trial. Digoxin use was assigned a cost by using the 1998 average wholesale price as reported by Red Book. On average, there were fewer hospitalizations in digoxin-treated patients. These patients had lower heart failure yet higher non-heart failure hospitalization costs than placebo patients. Digoxin therapy was cost saving versus placebo in only 27% of 1000 bootstrap samples using Medicare costs (mean costs 12,648 dollars vs. 12,362 dollars) and in 44% of samples using commercial carrier costs (mean costs 17,400 dollars vs. 17,306 dollars). How ever, digoxin was cost saving in >50% of samples for several higher-risk patient subgroups.

Conclusions: The use of digoxin therapy versus placebo was associated with reduced hospitalizations. Moreover, the resulting cost-savings could cover the costs of this inexpensive therapy in selected subgroups of higher-risk patients. In the remainder, there is a modest cost associated with this therapy.

MeSH terms

  • Aged
  • Cardiotonic Agents / therapeutic use*
  • Cost Control
  • Digoxin / therapeutic use*
  • Drug Costs
  • Female
  • Health Care Costs*
  • Heart Failure / drug therapy*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Medicare
  • Randomized Controlled Trials as Topic


  • Cardiotonic Agents
  • Digoxin