This economic evaluation estimated the 1-year health care cost offset and net cost of implementing quadruple GDMT (ARNI + β-blocker + MRA + SGLT2i) at discharge in adults ≥65 years hospitalized with HFrEF, using Medicare-linked GWTG-HF registry data from 2016–2020 (n=50,598).
Mean 1-year costs were $41,802/patient, with $25,172 driven by hospitalizations. Quadruple GDMT was modeled to reduce all-cause hospitalization costs by $9,780/patient/year (95% CI, $7,900–$11,660). With annual drug costs ranging $1,223–$16,136, net costs ranged from **$8,556 in savings to $6,347 in net cost**, with most regimens yielding net savings.
Treatment effects were modeled multiplicatively from separate pivotal RCTs rather than a single head-to-head trial of all four agents together; the cohort is limited to Medicare patients ≥65 years, limiting generalizability to younger adults; drug costs varied widely across pricing sources, creating a broad range of net-cost estimates.
For older adults hospitalized with HFrEF, starting full quadruple GDMT at discharge will often pay for itself by cutting rehospitalization costs—ask about formulary options to keep drug acquisition costs below the ~$9,800 hospitalization savings threshold. Prioritizing generic or lower-cost formulations of each drug class can tip most patients into net savings territory.
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