• Quality of Care and Outcomes

The SHIFT study showed that adding ivabradine to standard heart failure medication can improve prognosis, reduce hospitalisations, and improve quality of life in people with chronic heart failure and systolic dysfunction. These health and healthcare benefits need to be balanced against the costs of using the drug, which may be considerable with lifetime treatment, but up until now there has been no evidence on the combined costs and consequences of ivabradine in heart failure.

Griffiths et al1 used data from SHIFT to evaluate the cost-effectiveness of ivabradine. They developed a complex economic model to compare the lifetime costs and benefits of ivabradine plus standard care versus standard care alone in a subgroup of patients in the SHIFT trial with baseline resting heart rate ≥75 bpm (the licensed indication in Europe). Their base case incremental cost per quality adjusted life year (QALY) gained was £8498, which is below the £20 000 cost-effectiveness threshold recommended in England. They undertook many sensitivity analyses to see how robust the findings were to the model parameters and assumptions and found the results did not change appreciably—the cost-effectiveness of ivabradine remained below the cost-effectiveness threshold in virtually all scenarios.

It is worth noting that the economic model constructed by Griffiths et al was used in the manufacturer's submission to the National Institute for Health and Care Excellence (NICE) as part of its technology appraisal of ivabradine in people with chronic heart failure.2 An electronic version of the economic model was submitted, which was scrutinised in microscopic detail by an …