{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T11:27:28Z","timestamp":1777634848871,"version":"3.51.4"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Acute decompensated heart failure (ADHF) represents a major clinical and economic burden in Germany, primarily due to the frequent need for hospitalizations and high rehospitalization rates. Acetazolamide, a carbonic anhydrase inhibitor, has been shown in the ADVOR trial to improve early decongestion when added to loop diuretics. However, its economic impact within the German healthcare system has not yet been evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p>We developed a decision-analytic cost-effectiveness model using a 3-month time horizon to evaluate the addition of acetazolamide to standard diuretic therapy in hospitalized ADHF patients, based on data from the ADVOR trial. The analysis was conducted from the perspective of the German statutory health insurance (GKV). Model inputs included clinical probabilities, utilities from German heart failure populations, and healthcare costs (2025 values). Both deterministic and probabilistic sensitivity analyses were performed. A complementary budget impact analysis (BIA) estimated national-level financial implications under various adoption scenarios. In the base-case analysis, acetazolamide was technically dominant, incurring lower cost (4495\u20ac vs. 4959\u20ac per patient) and slightly higher quality-adjusted life years (QALYs: 0.132287 vs. 0.127710, difference 0.00458 \u2248 1.7 quality-adjusted days over 3 months) resulting in an ICER of \u2212101 449\u20ac per QALY. In a scenario using arm-specific outcomes from ADVOR, acetazolamide remained cost-saving with a minimal QALY decrement (\u22120.00024). The BIA estimated annual savings of \u20ac11\u2013217 million depending on uptake and patient eligibility, with \u20ac39 million under full uptake when ADVOR exclusion criteria are applied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Acetazolamide appears to be a cost-effective and potentially cost-saving adjunct to standard care in patients hospitalized with ADHF in Germany. Broad adoption of acetazolamide could reduce inpatient costs for ADHF, with potential annual savings ranging from tens to hundreds of millions of euros depending on eligibility and uptake.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcaf140","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T13:09:01Z","timestamp":1762434541000},"page":"296-304","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness and budget-impact analysis of Acetazolamide in decompensated heart failure patients with volume overload in the German health care system"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2043-4557","authenticated-orcid":false,"given":"Bent","family":"Estler","sequence":"first","affiliation":[{"name":"Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg , Im Neuenheimer Feld 410, Heidelberg 69120 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6355-476X","authenticated-orcid":false,"given":"Hanna","family":"Fr\u00f6hlich","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg , Im Neuenheimer Feld 410, Heidelberg 69120 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"T\u00e4ger","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg , Im Neuenheimer Feld 410, Heidelberg 69120 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7611-378X","authenticated-orcid":false,"given":"Norbert","family":"Frey","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg , Im Neuenheimer Feld 410, Heidelberg 69120 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lutz","family":"Frankenstein","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg , Im Neuenheimer Feld 410, Heidelberg 69120 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,11,25]]},"reference":[{"key":"2026042901115994000_qcaf140-B1","doi-asserted-by":"publisher","first-page":"2157","DOI":"10.1002\/ehf2.13948","article-title":"Heart failure in the general population and impact of the 2021 European Society of Cardiology Heart Failure Guidelines","volume":"9","author":"Wenzel","year":"2022","journal-title":"ESC Heart Fail"},{"key":"2026042901115994000_qcaf140-B2","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1007\/s00392-017-1137-7","article-title":"Epidemiology of heart failure in Germany: a retrospective database study","volume":"106","author":"St\u00f6rk","year":"2017","journal-title":"Clin Res Cardiol"},{"key":"2026042901115994000_qcaf140-B3","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1007\/s41669-023-00431-0","article-title":"Hospital resource utilization and costs in patients with heart failure in France","volume":"7","author":"Chemouni","year":"2023","journal-title":"Pharmacoecon Open"},{"key":"2026042901115994000_qcaf140-B4","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1111\/j.1527-5299.2007.06268.x","article-title":"Resource use in decompensated heart failure by disease progression categories","volume":"13","author":"Kane-Gill","year":"2007","journal-title":"Congest Heart Fail"},{"key":"2026042901115994000_qcaf140-B5","doi-asserted-by":"publisher","first-page":"2477","DOI":"10.1002\/ehf2.15277","article-title":"Signs of congestion, quality of life and short-term rehospitalization in patients with heart failure","volume":"12","author":"Voordes","year":"2025","journal-title":"ESC Heart Fail"},{"key":"2026042901115994000_qcaf140-B6","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1056\/NEJMoa2203094","article-title":"Acetazolamide in acute decompensated heart failure with volume overload","volume":"387","author":"Mullens","year":"2022","journal-title":"N Engl J Med"},{"key":"2026042901115994000_qcaf140-B7","volume-title":"Allgemeine Methoden: Version 8.0","author":"IQWiG","year":"2025"},{"key":"2026042901115994000_qcaf140-B8","doi-asserted-by":"publisher","first-page":"S59","DOI":"10.1016\/j.cardfail.2017.07.166","article-title":"Length of stay and hospital charges for heart failure admissions in the United States: analysis of the national inpatient sample","volume":"23","author":"Tashtish","year":"2017","journal-title":"J Card Fail"},{"key":"2026042901115994000_qcaf140-B9","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1007\/s12325-014-0147-3","article-title":"Ivabradine treatment in a chronic heart failure patient cohort: symptom reduction and improvement in quality of life in clinical practice","volume":"31","author":"Zugck","year":"2014","journal-title":"Adv Ther"},{"key":"2026042901115994000_qcaf140-B10","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.2147\/ppa.S88167","article-title":"Assessing patient preferences in heart failure using conjoint methodology","volume":"9","author":"Pisa","year":"2015","journal-title":"Patient Prefer Adherence"},{"key":"2026042901115994000_qcaf140-B11","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1007\/s40273-020-00984-6","article-title":"Health state utilities of patients with heart failure: a systematic literature review","volume":"39","author":"Di Tanna","year":"2021","journal-title":"Pharmacoeconomics"},{"key":"2026042901115994000_qcaf140-B12","doi-asserted-by":"publisher","first-page":"2546","DOI":"10.1002\/ehf2.13407","article-title":"Hospitalizations for heart failure: still major differences between East and West Germany 30 years after reunification","volume":"8","author":"D\u00f6rr","year":"2021","journal-title":"ESC Heart Fail"},{"key":"2026042901115994000_qcaf140-B13","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1002\/hec.4479","article-title":"The long-run effects of diagnosis related group payment on hospital lengths of stay in a publicly funded health care system: evidence from 15 years of micro data","volume":"31","author":"Arag\u00f3n","year":"2022","journal-title":"Health Econ"},{"key":"2026042901115994000_qcaf140-B14","doi-asserted-by":"publisher","first-page":"469580231167011","DOI":"10.1177\/00469580231167011","article-title":"Impact of diagnosis-related groups on inpatient quality of health care: a systematic review and meta-analysis","volume":"60","author":"Chen","year":"2023","journal-title":"Inquiry"},{"key":"2026042901115994000_qcaf140-B15","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1007\/s10741-024-10397-8","article-title":"Budget impact analyses for treatment of heart failure. A systematic review","volume":"29","author":"Teimourizad","year":"2024","journal-title":"Heart Fail Rev"},{"key":"2026042901115994000_qcaf140-B16","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1080\/14017431.2017.1311023","article-title":"Prevalence of heart failure in the elderly and future projections: the AGES-Reykjav\u00edk study","volume":"51","author":"Danielsen","year":"2017","journal-title":"Scand Cardiovasc J"},{"key":"2026042901115994000_qcaf140-B17","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1002\/1099-1050(200006)9:4&lt;277::aid-hec513&gt;3.0.co;2-1","article-title":"Hospital response to DRG refinements: the impact of multiple reimbursement incentives on inpatient length of stay","volume":"9","author":"Gilman","year":"2000","journal-title":"Health Econ"},{"key":"2026042901115994000_qcaf140-B18","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/1756-0500-4-135","article-title":"Inpatient hospital complications and lengths of stay: a short report","volume":"4","author":"Lagoe","year":"2011","journal-title":"BMC Res Notes"},{"key":"2026042901115994000_qcaf140-B19","doi-asserted-by":"publisher","first-page":"e011218","DOI":"10.1161\/circheartfailure.123.011218","article-title":"Economic modeling analysis of an intensive GDMT optimization program in hospitalized heart failure patients","volume":"16","author":"Dixit","year":"2023","journal-title":"Circ Heart Fail"},{"key":"2026042901115994000_qcaf140-B20","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.hjc.2022.04.006","article-title":"Real-world implementation of guidelines for heart failure management: a systematic review and meta-analysis","volume":"66","author":"Tsigkas","year":"2022","journal-title":"Hellenic J Cardiol"},{"key":"2026042901115994000_qcaf140-B21","doi-asserted-by":"publisher","first-page":"1096","DOI":"10.1001\/jama.2019.1153","article-title":"Choosing a time horizon in cost and cost-effectiveness analyses","volume":"321","author":"Basu","year":"2019","journal-title":"JAMA"},{"key":"2026042901115994000_qcaf140-B22","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1080\/13696998.2019.1588737","article-title":"Cost-effectiveness analyses using real-world data: an overview of the literature","volume":"22","author":"Bowrin","year":"2019","journal-title":"J Med Econ"},{"key":"2026042901115994000_qcaf140-B23","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"2026042901115994000_qcaf140-B24","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1007\/s00059-013-3955-3","article-title":"Demographic change and its impact on the health-care budget for heart failure inpatients in Germany during 1995\u20132025","volume":"38","author":"Schmidt","year":"2013","journal-title":"Herz"},{"key":"2026042901115994000_qcaf140-B25","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1016\/j.zefq.2014.06.018","article-title":"Decision making in Germany: is health economic evaluation as a supporting tool a sleeping beauty?","volume":"108","author":"Gerber-Grote","year":"2014","journal-title":"Z Evid Fortbild Qual Gesundhwes"}],"container-title":["European Heart Journal - Quality of Care and Clinical Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjqcco\/advance-article-pdf\/doi\/10.1093\/ehjqcco\/qcaf140\/65495749\/qcaf140.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/12\/3\/296\/65495749\/qcaf140.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/12\/3\/296\/65495749\/qcaf140.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T05:17:24Z","timestamp":1777439844000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article\/12\/3\/296\/8342041"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,25]]},"references-count":25,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,11,25]]},"published-print":{"date-parts":[[2026,4,29]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjqcco\/qcaf140","relation":{},"ISSN":["2058-5225","2058-1742"],"issn-type":[{"value":"2058-5225","type":"print"},{"value":"2058-1742","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2025,11,25]]}}}