[Cost-benefit analysis of spironolactone use in the treatment of chronic heart failure]

Chronic heart failure (CHF) is a disease with a high morbidity and mortality. The addition of spironolactone (25 mg/day) in the treatment of CHF has demonstrated a reduction in the mortality rate by 30% and in the hospitalization rate by 35%. The aim of this study was to perform a cost-benefit analysis of the association of spironolactone with the standard therapy for heart failure.

This analysis was carried out by assessing all the direct benefits and costs, derived from the association of either spironolactone or placebo with the standard therapy for heart failure in patients with functional degree III and IV. Data of costs and benefits were obtained from RALES. The following costs were included: hospitalisation, complementary tests and medication given. Benefit included avoided hospitalisations, complementary tests not performed and medication saved. The chosen perspective was the National Health Service and the time span chosen was of two years.

The cost/patient in the spironolactone group (293,653 pts.) was lower than in placebo group (402,353 pts.). The benefit/patient in the former group (615,690 pts.) was higher than in the latter group (542,014 pts.). The net benefit (benefit-cost) of the spironolactone group (322,037 pts.) was higher than that observed in the placebo group (139,661 pts.).

The association with spironolactone (25 mg/day) with the standard therapy for heart failure produces a remarkable net benefit in monetary terms. This fact will probably generate some resource saving for the National Health Service.