The pharmacoeconomics of peri‐operative beta‐blocker therapy

SummaryIt is widely recommended that beta‐blockade be used peri‐operatively as it may reduce the incidence of postoperative cardiovascular complications including death. However, there are few data concerning the cost‐effectiveness of such strategies. We have analysed the pharmacoeconomics of acute beta‐blockade using data from eight prospective peri‐operative studies in which patients underwent elective non‐cardiac surgery, and in which the incidence of adverse side‐effects of treatment, as well as clinical outcomes, have been reported. The costs of treatment were based on the NHS reference costs for 2004. From these data, the number‐needed‐to‐treat (NNT) to prevent a major cardiovascular complication (including cardiovascular death) in high‐risk patients was 18.5. This is comparable to the NNT for peri‐operative statin therapy. The incremental cost of peri‐operative beta‐blockade (costs of drug acquisition and of treating associated adverse drug events) was £67.80 per patient. This results in a total cost of £1254.30 per peri‐operative cardiovascular complication prevented. However, there is evidence that in patients at lower cardiovascular risk, beta‐blockers may be potentially harmful, since their adverse effects (hypotension, bradycardia) may outweigh their potential cardioprotective effects.