Resource utilization and costs in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme
1 Department of Cardiology, Level 4, Western Infirmary, Glasgow G11 6NT, Scotland, UK
2 AstraZeneca R&D, Lund, Sweden
3 Deparment of Cardiology, Hôpital Beaujon, Clichy, France
4 Franz-Volhard-Klinik, Berlin, Germany
5 University Hospital Gasthuisberg, Belgium
6 Department of Cardiology, University Hospital Groningen, Groningen, The Netherlands
7 Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
8 Duke University Medical Center, Durham, NC USA
9 HGM-McMaster Clinic, Hamilton, Ontario, Canada
10 Cardiovascular Division, Brigham and Women's Hospital, Boston, MA USA
11 Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
Received 29 September 2005; revised 8 March 2006; accepted 13 April 2006.
* Corresponding author. Tel: +44 141 211 1838; fax: +44 141 211 2252. E-mail address: j.mcmurray{at}bio.gla.ac.uk
Aims More treatments are needed to improve clinical outcomes in chronic heart failure (HF). It is, however, important that treatments for a condition as common as HF are affordable. We have carried out a prospective economic analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme.
Methods and results Patients with NYHA class II–IV HF and LVEF 
0.40 were randomized to CHARM-Alternative if intolerant of an ACE-inhibitor or to CHARM-Added if taking an ACE-inhibitor. Patients with a LVEF >0.40 were randomized in CHARM-Preserved. Each trial compared the effect of candesartan to placebo on the primary outcome of cardiovascular death or HF hospitalization. Detailed information was prospectively collected on hospital admissions, procedures/operations and drugs. A cost–consequence analysis was performed for France, Germany and the UK for CHARM-Overall and a cost-effectiveness analysis for the low LVEF trials. The cost of candesartan was substantially offset by a reduction in hospital admissions, especially for HF. In the cost–consequence analysis, candesartan was cost-saving in most scenarios for CHARM-Alternative and Added but the marginal annual net cost per patient was upto 
372 per year in CHARM-Preserved, in which candesartan did not reduce the primary outcome significantly. In the cost-effectiveness analysis of patients with a LVEF 0.40, candesartan was cost-saving in some scenarios and in the others the maximum cost per life year gained was 3881.
Conclusion Candesartan improves functional class, reduces the risk of hospital admission, and increases survival in patients with a HF and a LVEF 0.40 at an acceptable cost.
Key Words: Heart failure • Angiotensin receptor blocker • Health economics • Cost-effectiveness
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