Cost effectiveness of eplerenone in patients with chronic heart failure
Zanfina Ademi1, Kumar Pasupathi, Henry Krum
1Department of Medicine (Royal Melbourne Hospital), Melbourne EpiCentre, University of Melbourne, 7 East, Main Building, Grattan Street, Parkville, VIC, 3050, Australia, zademi@unimelb.edu.au.
Insights
Eplerenone is a cost-effective treatment for chronic systolic heart failure (NYHA class II), offering survival benefits and QALYs. This study evaluated its economic impact compared to placebo in heart failure patients.
Area of Science:
- Cardiology
- Health Economics
- Pharmacoeconomics
Background:
- Chronic heart failure (CHF) is a significant global health burden.
- Existing cost-effectiveness data for eplerenone in NYHA class II CHF patients is lacking.
- Eplerenone is a medication used in heart failure management.
Purpose of the Study:
- To assess the cost-effectiveness of eplerenone versus placebo in patients with chronic systolic heart failure and NYHA class II symptoms.
- To provide economic evidence for eplerenone's utility in a specific heart failure population.
Main Methods:
- A 10-year Markov model with yearly cycles was employed.
- Data from the EMPHASIS-HF study informed the model.
- Australian healthcare costs and published utility data were utilized, with a 5% discount rate.
Main Results:
- Eplerenone use was projected to save 0.5 discounted life-years and 0.4 discounted quality-adjusted life-years (QALYs) per person over 10 years compared to placebo.
- The net cost associated with eplerenone was A$6,117 per person.
- Incremental cost-effectiveness ratios were A$12,024 per life-year saved and A$16,700 per QALY saved.
- Sensitivity analyses confirmed the robustness of these findings.
Conclusions:
- Eplerenone demonstrates potential as a cost-effective strategy for managing chronic systolic heart failure in NYHA class II patients.
- The findings suggest eplerenone can reduce morbidity and mortality effectively within an economic framework.
Background:
Chronic heart failure (CHF) remains an important cause of morbidity and mortality worldwide. Currently, there are no cost-effectiveness studies of eplerenone use in patients with New York Heart Association (NYHA) class II CHF.
Objective:
We sought to evaluate the cost effectiveness of eplerenone compared with placebo in patients with chronic systolic heart failure and NYHA class II symptoms.
Methods And Results:
A 10-year Markov model with yearly cycles was constructed to evaluate the cost effectiveness of eplerenone compared with placebo, based on data from the EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization And Survival Study in Heart Failure) study. The model classified subjects into two health states: 'Alive with CHF' and 'Dead'. Information about the cost of disease was derived from Australian Refined Diagnosis-Related Groups (AR-DRG) data. The cost of eplerenone was taken from the Australian Pharmaceutical Benefit Scheme. Utility data were derived from published sources, and a 5 % annual discount rate was applied to future costs and benefits. Over 10 years, and compared with placebo, the model predicted that eplerenone would lead to a saving of 0.5 life-years (discounted) and 0.4 quality-adjusted life-years (QALYs) per person. The net cost was (in Australian dollars [$A]) $A6,117 (discounted) per person. These equated to incremental cost-effectiveness ratios of $A12,024 per life-year saved and $A16,700 per QALY saved. Sensitivity analyses indicated that these results were robust.
Conclusion:
Eplerenone may represent a cost-effective strategy for preventing morbidity and mortality among patients with chronic systolic heart failure and NYHA class II symptoms.
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