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Cost-effectiveness of eplerenone compared with placebo in patients with myocardial infarction complicated by left

William S Weintraub1, Zefeng Zhang, Elizabeth M Mahoney

  • 1Emory University, 1256 Briarcliff Rd, Suite 1N, Atlanta, GA 30306, USA. wweintr@emory.edu

Circulation
|February 23, 2005
PubMed

Insights

Eplerenone significantly reduces mortality in patients with heart failure after myocardial infarction. This aldosterone blocker is a cost-effective treatment, increasing life-years gained for improved patient outcomes.

Area of Science:

  • Cardiology
  • Pharmacoeconomics
  • Clinical Trials

Background:

  • Aldosterone blockade with eplerenone demonstrated reduced mortality in the EPHESUS trial for post-myocardial infarction patients with heart failure.
  • The EPHESUS study established eplerenone's efficacy in improving survival for this patient group.

Purpose of the Study:

  • To evaluate the cost-effectiveness of eplerenone compared to placebo in patients with left ventricular systolic dysfunction and heart failure post-acute myocardial infarction.
  • Assessing the economic value of eplerenone in improving survival and quality of life.

Main Methods:

  • A randomized trial of 6632 patients comparing eplerenone and placebo, with a mean follow-up of 16 months.
  • Coprimary endpoints included all-cause mortality and a composite of cardiovascular mortality/hospitalization.
  • Resource utilization (hospitalizations, outpatient services, medications) was analyzed, with eplerenone priced at $3.60/day.

Main Results:

  • Eplerenone use resulted in an increase of 0.06 to 0.13 life-years gained, depending on the survival data source used (Framingham, Saskatchewan, Worcester).
  • The incremental cost-effectiveness ratio ranged from $10,402 to $21,876 per life-year gained.
  • The cost of eplerenone over the trial period was $1391 higher compared to placebo.

Conclusions:

  • Eplerenone is effective in reducing mortality in patients with heart failure following an acute myocardial infarction.
  • The treatment is considered cost-effective based on standard criteria for increasing life-years.
  • Eplerenone offers a valuable therapeutic option for improving long-term outcomes in this high-risk population.
Abstract

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