Cost-effectiveness of aldosterone antagonists for the treatment of post-myocardial infarction heart failure

Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research
C McKennaS Palmer

Abstract

To assess the cost-effectiveness of eplerenone versus spironolactone as an adjunctive therapy to standard care in patients with heart failure (HF) following a myocardial infarction (post-MI) from the perspective of the National Health Service in the United Kingdom. A systematic review was conducted, and a Bayesian meta-regression approach was used to establish the relative effectiveness of eplerenone and spironolactone by using evidence from randomized controlled trials. A decision analytic model was developed to assess the costs and consequences associated with the primary outcome of the trials over a lifetime time horizon. The incremental cost-effectiveness ratio of eplerenone compared with that of standard care alone was £ 4457 and £ 7893 for each additional quality-adjusted life-year when 2-year and lifetime treatment duration was assumed, respectively. In both scenarios, spironolactone did not appear cost-effective compared with eplerenone. The results were sensitive to the higher relative effectiveness estimated for eplerenone compared with spironolactone from the meta-regression. When a class effect was assumed for the effect on mortality and hospitalizations, spironolactone emerged as the most cost-effective treatment. ...Continue Reading

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Citations

Mar 13, 2014·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Zanfina AdemiDanny Liew
Jan 28, 2014·European Journal of Heart Failure·Javaid IqbalFaiez Zannad
Apr 24, 2013·Nature Reviews. Cardiology·Luis E RohdeCarísi A Polanczyk

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