Editorial Pharmacoeconomics of beta-blockers: effective and cost-effective therapy in chronic heart failure

Ž.Chronic heart failure CHF is a major public health problem with high attendant morbidity and mortality. It is also a very common condition. It has been estimated that 4.8 million Americans have the disease with approximately 400 000 new cases diagnosed each year 1. In Australia, a recent survey in general practice found that 13.2 % of patients over the age of 60 were diagnosed as having either systolic or dias- tolic heart failure 2. Disease prevalence appears to be on the increase and is expected to reach 10 million cases in the US alone by 2007 1. CHF is also a major cause of hospitalisation, estimated to account for 2.8% of all hospital discharges and 22 % of all discharges for cardiovascular disease 1. Based on the above considerations, it is hardly surprising that CHF imposes a major economic bur-den on the health care system of most societies. Estimates of the percentage of total health care ex-penditure attributable to management of CHF range Ž. Ž. from 1.0 % Netherlands 3 to 1.9 % France 4. This Žanalysis includes in-patient care the major compo-.nent of health care costs for CHF, drug treatment, surgery, nursing home costs and outpatient visits. However, these analyses do not include indirect costs, such as loss of income and social security costs. Fur-thermore, these figures are approximately a decade out of date and may in fact be extremely conservative. With the ageing of the population, improved sur