Nesiritide Usage in Decompensated Heart Failure: Cost Effectiveness and Clinical Effectiveness

Background: Approximately 5 million Americans have heart failure, with 550,000 new cases diagnosed each year. In the United States, approximately 500 million USD is spent annually on drug treatment for heart failure alone. Cost-effective treatment that prevents hospitalization is of high priority when treating patients with heart failure. Nesiritide, a human B-type natriuretic peptide, is indicated for the treatment of patients with acutely decompensated heart failure. Objective: The purpose of this manuscript is to provide an overview of the clinical effectiveness of nesiritide as well as the pharmacoeconomics associated with its use. Methods: Recently published articles and abstracts were identified from Pubmed, Medline and IPA using the search terms ‘nesiritide’, ‘heart failure’, ‘pharmacoeconomic’ and ‘clinical effectiveness’. Results: Randomized, multicenter trials examining the efficacy of nesiritide in patients hospitalized with decompensated heart failure have shown nesiritide to be significantly more effective than placebo and nitroglycerin at lowering pulmonary capillary wedge pressure in patients with decompensated heart failure. Nesiritide has also shown safety and efficacy when used in an outpatient setting. Additionally, four studies have examined the pharmacoeconomics associated with the use of nesiritide. All four studies showed a decreased length of stay in either intensive care and critical care units or total hospital stay, and three of the four studies performed a cost analysis which demonstrated cost savings. Conclusion: In several studies, nesiritide has been shown to be similar or significantly more effective than standard therapy at improving the status of patients with decompensated heart failure while demonstrating cost savings and decreasing length of stay.