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Heart Failure Drug for Blacks a Good Deal

Study found Bidil cost 34% less than standard therapy over course of a year

TUESDAY, Dec. 13, 2005 (HealthDay News) -- The first heart failure drug geared specifically to blacks not only improves survival and reduces hospitalization rates among patients, but also results in cost savings.

"Doctors should probably give BiDil to blacks with grade III heart failure, and they should probably do it even if these patients are relatively well-managed on existing medications," said Dr. Derek C. Angus, lead author of a study in the Dec. 13 issue of Circulation.

"The data is important," added Dr. Hector Ventura, head of the cardiomyopathy and heart transplantation center at the Ochsner Clinic Foundation in New Orleans. "Whether or not other medicines work, at least we're focusing on the population that needs it."

Heart failure, a condition in which the heart loses its ability to pump, affects about 5 million Americans, including an estimated 750,000 blacks. And blacks aged 45 to 64 are two-and-a-half times more likely to die from heart failure than whites of similar age.

The discovery of BiDil as an effective heart failure therapy for blacks was an accident. It is actually a combination of two older drugs -- hydralazine, an anti-hypertensive agent that relaxes the arteries, and isosorbide dinitrate, an anti-anginal agent that relaxes the veins and arteries. Neither drug was approved for heart failure before clinical trials began, and it is still unclear how the two work together.

In an earlier trial, BiDil did not have much effect in white patients but did do well among black patients.

That trial was the impetus for the African-American Heart Failure Trial (A-HeFT), designed to look specifically at the effects of BiDil in more than 1,000 black heart patients.

A-HeFT found a 43 percent reduced risk of death (6.2 percent vs. 10.2 percent), 39 percent reduced risk of first hospitalization and improved quality of life among participants taking BiDil plus standard heart failure therapies when compared to those taking only standard therapies. Indeed, the results were so encouraging that the trial was halted early, in July 2004.

The current study is based on A-HeFT data, this time focusing on resource use, costs of care and cost-effectiveness within the same trial population. The study was funded by NitroMed Inc., which makes BiDil.

Individuals treated with BiDil had 30 percent fewer hospitalizations and shorter hospital stays (one day shorter) compared with the placebo group. This resulted in a 41 percent reduction in the number of days spent in the hospital for heart failure.

In the BiDil group, heart failure-related costs averaged $5,997 -- 34 percent lower than the $9,144 seen in the placebo group.

Total health-care costs averaged $15,384 in the BiDil group, which was 22 percent lower than the average of $19,728 in the placebo group.

The authors projected that, by using BiDil, heart failure-related costs would be $16,000 a year at two years after starting the drug.

With an average daily cost of $6.38, BiDil has been the subject of some controversy. If the two drugs were taken separately, the cost would be only pennies per day. This particular combination, however, has been patented and likely results in better patient compliance because it is one pill, not two.

According to this study, that extra cost is being more than made up for in reduced overall health-care costs.

"Regardless of what you think of the pricing policy, it's actually a cost savings, at least over the duration of the study period," said Angus, professor of critical care medicine and health policy and management at the University of Pittsburgh School of Medicine. "Six dollars a day is keeping the doctor away. It's decreasing the likelihood of acute hospitalization. One might think it's more than 60 cents, but it's a lot less than being hospitalized."

More information

The National Minority Health Month has more on heart failure in blacks.

SOURCES: Derek C. Angus, M.D., professor, critical care medicine and health policy and management, University of Pittsburgh School of Medicine; Hector Ventura, M.D., head, cardiomyopathy and heart transplantation center, Ochsner Clinic Foundation, New Orleans; Dec. 13, 2005, Circulation
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