Efficacy And Cost Analysis Of Levosimendan And Recombinant Human Natriuretic Peptide In The Treatment Of Acute Heart Failure

Background:Heart failure is a group of complex clinical syndromes,it is due to a variety of reasons which can cause abnormal changes of the cardiac structure and(or)function,cause the disorder of ventricular contraction and(or)diastolic function.It’s a variety serious performance or late stage of cardiovascular disease.The epidemiological survey in recent years shows that the prevalence of heart failure in adults over 35 years old has reached 1.3%in China,and the estimated number of heart failure patients has reached 13.7 million.With the continuous aggravation of the aging population in China,the number of chronic diseases such as coronary heart disease,hypertension,diabetes and obesity continues to increase,which will lead the continuous increase of the number of patients with heart failure in China.According to the China-HF registry,the hospital length of stay was 10 days for patients with heart failure,while the in-hospital mortality was as high as 4.1%.High rehospitalization rates,long hospital stays,and high mortality rates have become the significant characteristics of heart failure.Heart failure is a fortress that has not yet been overcome in the field of cardiovascular disease,and the high cost for the treatment of heart failure during hospitalization,brings a heavy burden to family and society.For the medical treatment of acute heart failure,we mainly rely on diuretics,vasodilators,and inotropic drugs currently.As a kind of calcium sensitizer,Levosimendan is a new type of inotropic drugs.It is combined with cardiac troponin C to increase myocardial contractility and has no effect on cardiac dilation.It has vasodilatory properties on peripheral arteries and veins in all vascular territories also.Recombinant human natriuretic peptide,as the representative drug of vasodilators,mainly reduces the load of the heart by dilating the veins and arteries,and has certain natriuretic effect.Both the two drugs can obviously improve the hemodynamics and relieve symptoms of dyspnea or other related symptoms in patients with acute heart failure.A series of clinical studies have proved their therapeutic effects and safeties from different angles.There is no doubt about the therapeutic effect of both on acute heart failure.Both of them have been written as a recommended drug in the heart failure guidelines of various countries,and are currently widely used in clinical.When we treat the patients with acute heart failure,we often choose different treatment options to help patients through the acute phase according to the patient’s condition,such as choosing one of the two drugs to be used alone or two drugs to be used in combination.However,the prices of these two drugs are relatively high,which has a certain impact on the treatment cost of patients with heart failure.At the same time,different treatment options will also have different therapeutic effects.Currently,there is few studies on the relationship between the cost and the effect of different treatment options.This requires us to use the cost-effectiveness analysis method in pharmacoeconomics within the limited medical resources to compare the benefits and costs obtained by different drug treatment options,and select a relatively optimal result,so as to provide more information for clinicians to make decision.Based on the above situation,this study used the relevant information of patients with heart failure during hospitalization to explore the efficacy and cost analysis of levosimendan and recombinant human natriuretic peptide in the treatment of acute heart failure.Objective:1.To investigate the effect of levosimendan and recombinant human natriuretic peptide on the efficacy of acute heart failure.2.Cost-effectiveness analysis of leosimendan and recombinant human natriuretic peptide in the treatment of acute heart failureMethods:A retrospective case analysis was performed in the patients who were diagnosed with acute heart failure and hospitalized in the Department of Cardiology,Qilu Hospital of Shandong University from January 1,2018 to December 31,2018.A total of 147 patients were selected according to the inclusion criteria and exclusion criteria.We record the general information of the patients to electronic archives,including age,gender,height,weight,smoking history,drinking history,disease history,resting blood pressure and resting heart rate at admission and discharge,heart failure causes,symptoms and signs of heart failure,echocardiography(mainly LVEF and LVEDD),NT-proBNP,blood routine examination,liver and kidney function,blood glucose,blood lipid,electrolyte,thyroid function,D-Di,drugs,hospitalization days and hospitalization costs and other data,set up the database.According to the application of levosimendan and recombinant human natriuretic peptide,they were divided into 3 groups:levosimendan group:the patients received conventional treatment and levosimendan treatment,Recombinant human natriuretic peptide group:conventional treatment and recombinant human natriuretic peptide treatment,combined treatment group:the patients were treated with conventional treatment and levosimendan combined with recombinant human natriuretic peptide.According to the criteria for curative effect,the treatment effect is divided into marked effect,effective and no effect.The total effective rate is(marked effect and effective)/total number of people x100%.The total hospitalization cost and total effective rate were used to calculate and analyze the cost-effect ratio and the incremental cost-effect ratio between different groups.Data is analyzed using SPSS25.0 software,the measurement data needs to be tested for normality.The measurement data that meets the normal distribution are expressed in the form of mean ± standard deviation(x±s),and the comparison method between groups was used Single-factor analysis of variance,and the comparison method within the group used paired sample T test.The measurement data that did not meet the normal distribution were expressed in the form of quartile M(Q1,Q3),and the comparison method between groups used a non-parametric test.The comparison method within the group uses Wilcoxon’s symbolic rank test.The rank data is expressed by the number of cases or percentage(%),the comparison method between groups uses the Ridit analysis.The count data is expressed by the number of cases or percentage(%),and the chi-square test is used for the comparison method between groups.In all tests,P<0.05 was considered statistically significant.Results:(1)Comparison of general clinical data:age,sex ratio,height,smoking history,drinking history,admission NT-proBNP,hemoglobin(HGB),blood albumin(ALB),liver function(ALT,AST),renal function(Cr,BUN),blood lipid(LDL-c),blood potassium(K+),precipitants and main causes of heart failure,admission heart function classification(NYHA classification)and heart failure comorbidities were compared between three groups.The difference was not statistically significant(P>0.05).(2)Comparison of LVEF and LVEDD:In terms of LVEF,the levosimendan group was compared with the recombinant human natriuretic peptide group and the combined treatment group,and the difference was not statistically significant(P>0.05).Compared with the combined treatment group,the LVEF value of the recombinant human natriuretic peptide group was significantly higher,and the difference was statistically significant(P<0.05).In terms of LVEDD,there was no statistically significant difference between three groups(P>0.05).(3)Drug use during hospitalization:Of the 147 patients included in this study,the total usage rate of RAAS inhibitors during hospitalization was 84.4%,the total usage rate of β-blockers was 93.9%,and the total usage rate of aldosterone receptor antagonists 94.6%,the total use rate of intravenous diuretic drugs was 97.3%,and there was no statistically significant difference in the use of the above drugs among the three groups(P>0.05).(4)Comparison of heart rate between admission and discharge:The discharge heart rate of patients in the recombinant human natriuretic peptide group and the combination treatment group were significantly slower than the heart rate of admission,and the difference was statistically significant(P<0.001);However,there was no statistically significant difference between the discharge and admission heart rates of patients in the levosimendan group(P>0.05).(5)Comparison of blood pressure between admission and discharge:The systolic and diastolic blood pressures of the three groups were significantly lower at discharge than at the time of admission.The difference was statistically significant(P<0.001).(6)Comparison of weight between admission and discharge:Patients in the combined treatment group had significantly reduced weight at discharge compared with that at admission,and the difference was statistically significant(P<0.05).However,there was no significant difference in the discharge weight of patients in the levosimendan group and the recombinant human natriuretic peptide group compared with the time of admission(P>0.05).(7)Comparison of NT-proBNP between admission and discharge:The NT-proBNP measured at the last time before discharge in three groups were significantly lower than that at admission.The difference was statistically significant(P<0.001).(8)Comparison of the decrease of NT-proBNP level:Ridit analysis was used to compare the decrease of NT-proBNP level,suggested the levosimendan group performance best on the decrease of NT-proBNP level,then the combined treatment.group,and the recombinant human natriuretic peptide group was the worst,but there was no statistically significant difference between the three groups(P>0.05).(9)Comparison of hospitalization days:The median hospitalization days of patients in the levosimendan group,the recombinant human natriuretic peptide group and the combined treatment group were 10,11 and 12 days,respectively.There was no statistically significant difference between the three groups(P>0.05).(10)Comparison of treatment effect:Ridit analysis was used to compare the treatment effect,indicating that the treatment effect was the best in the levosimendan group,followed by the combined treatment group,and the recombinant human natriuretic peptide group was the worst,but the difference between the three groups was not statistically significant(P>0.05).In terms of the total effective rate,the total effective rate was 81.3%in the levosimendan group,67.4%in the recombinant human natriuretic peptide group,and 72.5%in the combined treatment group,with no statistically significant difference between the three groups(P>0.05).(11)Comparison of total hospitalization costs:the total hospitalization costs of the levosimendan group were significantly lower than that of the recombinant human natriuretic peptide group and the combined treatment group,and the difference was statistically significant(P<0.05).The total hospitalization cost in the combined treatment group was significantly higher than that in the levosimendan group and the recombinant human natriuretic peptide group,and the difference was statistically significant(P<0.05).(12)Comparison of average daily hospitalization costs:the average daily hospitalization costs of the levosimendan group were significantly lower than that of the recombinant human natriuretic peptide group and the combined treatment group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in average daily hospital costs between the recombinant human natriuretic peptide group and the combined treatment group(P>0.05).(13)Cost-effectiveness analysis:For each 1%of the treatment effect,the cost of the levosimendan group was the least(RMB 150.11).The treatment cost of recombinant human natriuretic peptide group was in the middle(RMB 275.95).The combined treatment group needed the most treatment cost(RMB 284.82).Compared with the recombinant human natriuretic peptide group,for each 1%increase in therapeutic effect,the levosimendan group saved 460.06 yuan,and the combined treatment group cost 402.07 yuan more.(14)Sensitivity analysis:The sensitivity analysis results are consistent with the cost-effectiveness analysis results.Conclusion:1.Levosimendan,recombinant human natriuretic peptide and the combination of the two drugs have obvious therapeutic effects on patients with heart failure,and can significantly decrease the NT-proBNP level more than 50%.There is no significant difference in the therapeutic effect of the three options.2.The combined treatment group had the highest hospitalization costs,followed by the recombinant human natriuretic peptide group,and the levosimendan group had the lowest hospitalization costs.3.The total effective rate of levosimendan monotherapy for heart failure is the highest and the cost was the lowest,it’s the best cost-effective treatment,and the other two options can be selected according to the patient’s condition,economic conditions and willingness.