I farmaci per lo scompenso cardiaco: criteri di scelta razionale e costo-efficace

Abstract

Chronic heart failure (CHF) is the final phase of many common cardiovascular diseases. Consequently, it represents a frequent clinical condition: it’s estimated that in developed countries, Italy included, its prevalence exceeds 3%. CHF is also burdensome from an economical point of view, as it absorbs more than 2% of the Italian total health care budget. The main cost driver in CHF, accounting for approximately two thirds of its total expense, is represented by hospital admissions for relapse. The most frequent reason for relapse, in turn, is inadequate treatment, intended both as low patient compliance to prescribed drug regimens and as inappropriate prescribing. Evidence-based guidelines for the optimal pharmacological treatment of CHF have been developed and are constantly updated, and it’s demonstrated that the stricter the adherence to these recommendations, the better the clinical and economic outcomes. Pharmacoeconomic studies conducted on the use of ACE-inhibitors and beta-blockers, in particular, have shown that correct therapeutic strategies can be cost-saving in CHF management, besides providing important clinical benefits. The expansion of generic drug market has brought by a reduction in pharmaceutical prices, allowing to offer the benefits of these highly effective, and cost-effective, treatments for CHF to a larger number of patients, without increasing the global pharmaceutical expense, but probably reducing the total economical burden of the disease.