Angiotensin-Converting Enzyme Inhibitor Therapy in Patients with Heart Failure Enrolled in a Managed Care Organization: Effect on Costs and Probability of Hospitalization

Study Objective. To evaluate the effect of angiotensin-converting enzyme (ACE) inhibitor therapy on risk of hospitalization and resource utilization in patients with heart failure enrolled in a managed care organization. Design. Retrospective medical and pharmacy claims analysis. Patients. One thousand five hundred seventy-three patients with heart failure enrolled in a managed care organization. Measurements and Main Results. Medical and pharmacy claims from January 1, 1997-December 31, 1999, from a managed care organization covering approximately 350,000 individuals were analyzed. Patients aged 35 years or older with a diagnostic code for heart failure and 18 months of continuous eligibility were selected. From this group (1573 patients), two cohorts were selected based on exposure to an ACE inhibitor. Dependent variables of interest were all-cause hospitalization and total direct medical costs during the 12-month study period. A logistic regression model and an ordinary least-squares model adjusting for patient demographics, comorbidities, and concomitant drug therapy were used to analyze the risk of all-cause hospitalization and total direct medical costs, respectively. Therapy with an ACE inhibitor for 180 days was associated with a decreased risk of all-cause hospitalization (odds ratio 0.65, p<0.0001) and lower total costs (mean $2397, p<0.001) compared with no ACE inhibitor therapy. Conclusion. In patients with a diagnosis of heart failure, exposure to ACE inhibitor therapy is associated with fewer hospitalizations and lower total costs than no ACE inhibitor exposure.