Cost-effectiveness of levosimendan in patients with exacerbation of chronic heart failure — a single-center perspective

Introduction: Heart failure (HF) places a significant economic burden on the health care system all over the world mainly due to frequent and repetitive hospitalizations. Thus, there is a need for both cost-effective and efficient therapeutic options. The aim of the study was to describe the economic aspect of levosimendan treatment in hospitalized HF patients in one major Polish cardiology unit. Material and methods: Retrospective observational study included 1086 patients with exacerbation of chronic HF, admitted to the Cardiology Department, University Hospital No 1 in Bydgoszcz, Poland in 2018–2020. We analyzed the cost of therapy, cost and the length of stay of 1057 hospitalizations of patients receiving standard therapy (ST) only and 29 hospitalizations of patients receiving levosimendan (Levo) on top. Levosimendan was used in patients not responding to standard therapy, mostly as a drug of the last chance. Results: The mean length of hospital stay for the ST patients was 9.4 days compared to 29.1 days for the Levo group. The median total cost of hospitalization of patients receiving ST was significantly lower compared to Levo group [PLN 6,612.5 (IQR 3,624.9—13,301.3) vs PLN 23,854.9 (IQR 10,900.4–40,391.5), p < 0.001]. On the other hand, the median daily cost of hospitalization did not differ between the ST and Levo group [PLN 772 (616.4–1,629) vs PLN 1,010.5 (IQR 787.4–1,172), p = 0.1]. The total cost of treatment was significantly lower only in the ST subgroup hospitalized for less than 2 weeks compared to the Levo group (p = 0.008). An early decision of levosimendan introduction (up to 8 days) resulted in a shorter hospitalization time compared to later drug administration (21 days vs 42 days; p = 0.019). Conclusions: Early administered levosimendan in HF exacerbation seems to be cost-effective in Polish clinical and economic settings. Despite the high cost of drug acquisition, it may provide better outcomes at lower overall costs of HF patient management. A randomized trial will be necessary to address this issue in Poland.