Dr. med. Bent Estler · Heidelberg
Cardioeconomics

The value and affordability of cardiovascular care.

From clinical progress to economic value

What better care
is worth.

Evidence on treatment benefit is only part of the picture. My research explores value, affordability, and access in cardiovascular medicine.

Read the research ↓
Research collection / 2022–2026Five health economic publications

Publications & perspectives

Author record on PubMed ↗
Amyloid cardiomyopathy / 2026

The affordability of innovation

Acoramidis
Editor’s Choice ↗

European Heart Journal – Quality of Care and Clinical Outcomes

€633,081per additional QALYLifetime base-case estimate

Acoramidis offers a new treatment option for transthyretin amyloid cardiomyopathy. This study asks how its clinical benefits translate into economic value and expenditure for German statutory health insurance.

Main findings

The model estimated 1.286 additional quality-adjusted life-years at an additional lifetime cost of €814,246 per patient. First-year expenditure ranged from €80.8 million to €269.4 million across the modelled uptake scenarios.

Why it matters

Clinical benefit and affordability need to be considered together. At the evaluated price, the findings support a substantial reduction in acquisition cost to improve economic value.

Methods & full citation

A cohort Markov model combined trial-based survival extrapolation, KCCQ-derived utilities, and direct medical costs. Survival scenarios produced ICERs from approximately €459,000 to €2.14 million per QALY.

Affordability of innovation: cost-effectiveness and budget impact analysis of acoramidis in transthyretin amyloid cardiomyopathy in the German healthcare system.

Bent Estler; Hanna Fröhlich; Tobias Täger; Lutz Frankenstein. European Heart Journal – Quality of Care and Clinical Outcomes. 2026;12(6):1053–1064. DOI: 10.1093/ehjqcco/qcag093.

HFpEF & obesity / 2026

Value for patients. Pressure on budgets.

Semaglutide

PharmacoEconomics

€30,443per additional QALYFive-year base-case estimate

Improvements in symptoms and body weight are important to patients with obesity-related HFpEF. This analysis examines their economic value and the financial implications of wider treatment access in Germany.

Main findings

The five-year model estimated 0.163 additional QALYs, with an ICER of €30,443 per QALY. Over one year, the ICER was €82,237 per QALY; estimated first-year budget impact was €168–864 million.

Why it matters

A treatment can offer favourable value under the model assumptions while still requiring substantial additional funding. Longer-term treatment-effect assumptions matter.

Methods & full citation

A KCCQ-based Markov model evaluated semaglutide against placebo, both on background care. Time-horizon and structural trajectory scenarios examined uncertainty beyond the observed trial period.

Cost-Effectiveness and Budget-Impact Analysis of Semaglutide in Heart Failure with Preserved Ejection Fraction and Obesity in the German Health-Care System.

Bent Estler; Hanna Fröhlich; Tobias Täger; Norbert Frey; Lutz Frankenstein. PharmacoEconomics. 2026;44:1077–1092. DOI: 10.1007/s40273-026-01621-4.

HFpEF & obesity / 2026

From trial benefit to population spending

Tirzepatide

International Journal of Cardiology

€252,611per additional QALYFive-year base-case estimate

SUMMIT established clinical benefits for tirzepatide in HFpEF with obesity. The economic question is whether those gains justify the treatment cost and what broad adoption would mean for German healthcare budgets.

Main findings

The model estimated an additional 0.100 QALYs and €25,225 per patient. Five-year incremental spending ranged from €1.9–6.2 billion with SUMMIT-like eligibility and €3.8–12.6 billion with broader eligibility.

Why it matters

Price, eligible population size, and uptake all shape implementation. At the evaluated price, the model showed a low probability of cost-effectiveness at €100,000 per QALY.

Methods & full citation

A five-year Markov model used SUMMIT-derived health-state transitions and event rates. Price-reduction scenarios and probabilistic sensitivity analysis examined value and uncertainty.

Cost-effectiveness and budget-impact analysis of tirzepatide in heart failure with preserved ejection fraction and obesity in the German health-care system.

Bent Estler; Hanna Fröhlich; Tobias Täger; Jannick Heins; Norbert Frey; Lutz Frankenstein. International Journal of Cardiology. 2026;458:134560. DOI: 10.1016/j.ijcard.2026.134560.

Acute heart failure / 2026

The economic potential of an established drug

Acetazolamide

European Heart Journal – Quality of Care and Clinical Outcomes

€464lower cost per patientThree-month base-case estimate

Hospital care accounts for a major part of the economic burden of acute heart failure. The analysis evaluates adding acetazolamide to standard diuretic treatment in the German healthcare system.

Main findings

Base-case costs fell from €4,959 to €4,495 per patient, with a small gain of 0.00458 QALYs. A scenario using arm-specific ADVOR outcomes remained cost-saving, with a small QALY loss of 0.00024.

Why it matters

The principal economic signal is lower expenditure. Estimated annual savings were €39 million at full uptake under ADVOR-based exclusions, with wider scenarios depending on eligibility and uptake.

Methods & full citation

A three-month decision-analytic model examined costs and outcomes from the statutory insurance perspective, alongside a national budget-impact analysis. The health gain was small and scenario-dependent.

Cost-effectiveness and budget-impact analysis of Acetazolamide in decompensated heart failure patients with volume overload in the German health care system.

Bent Estler; Hanna Fröhlich; Tobias Täger; Norbert Frey; Lutz Frankenstein. European Heart Journal – Quality of Care and Clinical Outcomes. 2026;12(3):296–304. DOI: 10.1093/ehjqcco/qcaf140.

Structural heart disease / 2023

Valuing transcatheter mitral valve repair

MitraClip

The European Journal of Health Economics

€59,728per additional QALYGerman statutory insurance perspective

My first publication grew out of my doctoral research in Cologne. It evaluated MitraClip plus optimal medical therapy for heart failure with secondary mitral regurgitation in the German setting.

Main findings

The analysis estimated €59,728 per additional QALY. At a willingness-to-pay threshold of €67,000 per QALY, the probability of cost-effectiveness was 80%.

Why it matters

Economic value depends on the decision threshold and clinical assumptions. The study connects COAPT evidence with the costs and resource decisions of the German healthcare system.

Methods & full citation

The model used COAPT survival and hospitalisation data, published utilities, and German costs. Transition probabilities and hospitalisation rates were important drivers of uncertainty.

Cost-effectiveness of the MitraClip device in German heart failure patients with secondary mitral regurgitation.

Bent Estler; Volker Rudolph; Yana Seleznova; Arim Shukri; Stephanie Stock; Dirk Müller. The European Journal of Health Economics. 2023;24:349–358 · Online 2022. DOI: 10.1007/s10198-022-01476-4.

QALY = quality-adjusted life-year; ICER = incremental cost-effectiveness ratio. Results depend on each study’s population, comparator, prices, and time horizon. These estimates are not a head-to-head comparison of treatments. Willingness-to-pay values are analytical thresholds, not official German reimbursement thresholds.

The researcher

Dr. med.
Bent Estler

I am a medical doctor in the Department of Cardiology, Angiology and Pulmology at Heidelberg University Hospital. I studied medicine at the University of Cologne and have worked in Heidelberg since 2021.

My doctoral research at Cologne’s Institute of Health Economics and Clinical Epidemiology examined the cost-effectiveness of MitraClip in the German healthcare system. It led to my first publication and continues to shape my interest in the value and affordability of cardiovascular care.

The next research questions

My future research focuses on health economic modelling in cardiovascular medicine: cost-effectiveness, budget impact, pricing and eligibility scenarios, and transparent analysis of decision uncertainty.

Research correspondence

Good research starts with a conversation.

I welcome opportunities to exchange ideas and explore research collaborations in cardiovascular medicine and health economics. Please get in touch if you share these interests or have a research question you would like to discuss.