Cost regulators for the National Health Service have further endorsed the use of Servier's Procoralan to treat a certain subgroup of patients with chronic heart failure (CHF).

The National Institute for Health and Clinical Excellence has now published final draft guidance recommending Procoralan (ivabradine) as an option for treating CHF, specified as NYHA class II to IVi.

It has, however, stipulated that the drug should only be used in patients with systolic dysfunction, those who are in sinus rhythm, when the heart rate is 75 beats per minute or more, and for those who have a left ventricular ejection fraction of 35% or less.

The draft guidelines also state that Procoralan should be taken alongside standard therapy, such as including beta-blockers or angiotensin-converting enzyme (ACE) inhibitors, or when a patient is unable to take/tolerate beta-blockers.

Heart failure is a complex clinical syndrome that affects about 900,000 people in the UK, a number that is on the rise given the improving prognosis of coronary artery disease, the ageing population and the availability of more effective therapies. 

Room for improvement

But around 30% to 40% of patients diagnosed with heart failure still die within a year, highlighting that there is still much room for improvement.

In addition, heart failure accounts for 2% of all NHS inpatient bed-days and 5% of all emergency medical admissions to hospital, and hospital admissions as a direct result of the condition are forecast to rocket by 50% over the next 25 years.

Treatment strategies center on improving life expectancy and quality of life for patients, but also aim to avoid such costly hospitalisations at the same time.

Clinical trials of Procoralan have demonstrated the its potential to reduce mortality and improve quality of life in some patients with CHF. 

Its expected clinical benefits, coupled with a price-tag of £40.17 per 56-tablet pack, led the NICE's Appraisal Committee to conclude that the incremental cost for the drug is likely to be around £8,500 per QALY (quality adjusted life year), and that it is therefore likely to represent value for money in this setting. 

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