Abstract
Aims
Following the results of the EPHESUS study in patients with heart failure after myocardial infarction, a cost-effectiveness analysis was undertaken from a Dutch societal perspective to evaluate the lifetime benefits and costs of eplerenone as add-on to standard treatment.
Methods
Life-years gained in the eplerenone arm during the trial period were extrapolated to lifetime life-years gained using three sources of life expectancy data (Framingham Heart Study, Saskatchewan Health Database and Worcester Heart Attack Registry). Resource use measured included direct medical costs of hospitalisation, medications including eplerenone, outpatient diagnostic tests and procedures, and emergency room visits. Incremental cost-effectiveness ratios were calculated for life-years gained and quality-adjusted life-years gained.
Results
Eplerenone prolonged lifetime survival by five weeks at an additional cost of €803. The incremental cost-effectiveness ratio was about €8000 per life-year gained, well below the only published Dutch benchmark for cost-effectiveness of €18,000. Probabilistic sensitivity analyses showed the results to be robust when varying the discount rate applied to benefits and costs, the hospitalisation costs, and the source of life expectancy data used.
Conclusion
Treatment with adjunctive eplerenone is effective in preventing deaths and prolonging life.
Keywords: heart failure, cost-effectiveness, aldosterone blockade, eplerenone
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Selected References
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- Berry C., Murdoch D. R., McMurray J. J. Economics of chronic heart failure. Eur J Heart Fail. 2001 Jun;3(3):283–291. doi: 10.1016/s1388-9842(01)00123-4. [DOI] [PubMed] [Google Scholar]
- Goldberg R. J., Yarzebski J., Lessard D., Gore J. M. A two-decades (1975 to 1995) long experience in the incidence, in-hospital and long-term case-fatality rates of acute myocardial infarction: a community-wide perspective. J Am Coll Cardiol. 1999 May;33(6):1533–1539. doi: 10.1016/s0735-1097(99)00040-6. [DOI] [PubMed] [Google Scholar]
- Jukema J. W., Simoons M. L. Treatment and prevention of coronary heart disease by lowering serum cholesterol levels; from the pioneer work of C.D. de Langen to the third "Dutch Consensus on Cholesterol". Acta Cardiol. 1999 Jun;54(3):163–168. [PubMed] [Google Scholar]
- Linné A. B., Liedholm H., Jendteg S., Israelsson B. Health care costs of heart failure: results from a randomised study of patient education. Eur J Heart Fail. 2000 Sep;2(3):291–297. doi: 10.1016/s1388-9842(00)00089-1. [DOI] [PubMed] [Google Scholar]
- Peeters A., Mamun A. A., Willekens F., Bonneux L. A cardiovascular life history. A life course analysis of the original Framingham Heart Study cohort. Eur Heart J. 2002 Mar;23(6):458–466. doi: 10.1053/euhj.2001.2838. [DOI] [PubMed] [Google Scholar]
- Pitt B., Zannad F., Remme W. J., Cody R., Castaigne A., Perez A., Palensky J., Wittes J. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999 Sep 2;341(10):709–717. doi: 10.1056/NEJM199909023411001. [DOI] [PubMed] [Google Scholar]
- Pitt Bertram, Remme Willem, Zannad Faiez, Neaton James, Martinez Felipe, Roniker Barbara, Bittman Richard, Hurley Steve, Kleiman Jay, Gatlin Marjorie. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003 Mar 31;348(14):1309–1321. doi: 10.1056/NEJMoa030207. [DOI] [PubMed] [Google Scholar]
- Schulman K., Burke J., Drummond M., Davies L., Carlsson P., Gruger J., Harris A., Lucioni C., Gisbert R., Llana T. Resource costing for multinational neurologic clinical trials: methods and results. Health Econ. 1998 Nov;7(7):629–638. doi: 10.1002/(sici)1099-1050(1998110)7:7<629::aid-hec378>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
- Spencer F. A., Meyer T. E., Goldberg R. J., Yarzebski J., Hatton M., Lessard D., Gore J. M. Twenty year trends (1975-1995) in the incidence, in-hospital and long-term death rates associated with heart failure complicating acute myocardial infarction: a community-wide perspective. J Am Coll Cardiol. 1999 Nov 1;34(5):1378–1387. doi: 10.1016/s0735-1097(99)00390-3. [DOI] [PubMed] [Google Scholar]
- Steg Philippe Gabriel, Dabbous Omar H., Feldman Laurent J., Cohen-Solal Alain, Aumont Marie-Claude, López-Sendón José, Budaj Andrzej, Goldberg Robert J., Klein Werner, Anderson Frederick A., Jr Determinants and prognostic impact of heart failure complicating acute coronary syndromes: observations from the Global Registry of Acute Coronary Events (GRACE). Circulation. 2004 Jan 26;109(4):494–499. doi: 10.1161/01.CIR.0000109691.16944.DA. [DOI] [PubMed] [Google Scholar]
- Weintraub William S., Zhang Zefeng, Mahoney Elizabeth M., Kolm Paul, Spertus John A., Caro Jaime, Ishak Jack, Goldberg Robert, Tooley Joseph, Willke Richard. Cost-effectiveness of eplerenone compared with placebo in patients with myocardial infarction complicated by left ventricular dysfunction and heart failure. Circulation. 2005 Feb 21;111(9):1106–1113. doi: 10.1161/01.CIR.0000157146.86758.BC. [DOI] [PubMed] [Google Scholar]