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Cost Effectiveness of Eplerenone in Patients with Chronic Heart Failure

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American Journal of Cardiovascular Drugs Aims and scope Submit manuscript

Abstract

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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Conflict of interest

Zanfina Ademi declares no conflict of interest. Kumar Pasupathi acknowledges funding from Pfizer for part-time employment on unrelated health economic projects. Henry Krum has received travel support as part of the steering committee for EMPHASIS-HF. Danny Liew has received honoraria and research grants from Pfizer Australia.

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Correspondence to Zanfina Ademi.

Appendix

Appendix

Please see Table 5.

Table 5 Probabilities of death among Australians in 2007, by 5-year age-groups

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Ademi, Z., Pasupathi, K., Krum, H. et al. Cost Effectiveness of Eplerenone in Patients with Chronic Heart Failure. Am J Cardiovasc Drugs 14, 209–216 (2014). https://doi.org/10.1007/s40256-014-0066-3

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