Cost Effectiveness of Eplerenone in Patients with Chronic Heart Failure
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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.
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.
Eplerenone may represent a cost-effective strategy for preventing morbidity and mortality among patients with chronic systolic heart failure and NYHA class II symptoms.
- Smith DH, Johnson ES, Blough DK, Thorp ML, Yang X, Petrik AF, et al. Predicting costs of care in heart failure patients. BMC Health Serv Res. 2012;12:434. CrossRef
- Roger VL. Epidemiology of heart failure. Circ Res. 2013;113(6):646–59. CrossRef
- Tendera M. Epidemiology, treatment, and guidelines for the treatment of heart failure in Europe. Eur Heart J Suppl. 2005;7(J):J5–9. CrossRef
- National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand (Chronic Heart Failure Guidelines Expert Writing Panel). Guidelines for the prevention, detection and management of chronic heart failure in Australia. Updated October 2011.
- Herzog E, Varley C, Kukin M. Pathway for the management of acute heart failure. Crit Pathw Cardiol. 2005;4(1):37–42. CrossRef
- Krum H, Abraham WT. Heart failure. Lancet. 2009;373(9667):941–55. CrossRef
- AIHW. National Hospital Morbidity Database: separation statistics by principal diagnosis in ICD-10-AM, Australia, 2008–09 to 2009–10; 2011. http://www.aihw.gov.au/hospitals-data-cube/?id=10737419429. Accessed 8 May 2011.
- Whellan DJ, Greiner MA, Schulman KA, Curtis LH. Costs of inpatient care among Medicare beneficiaries with heart failure, 2001 to 2004. Circ Cardiovasc Qual Outcomes. 2010;3(1):33–40. CrossRef
- Zannad F, McMurray JJV, Krum H, van Veldhuisen DJ, Swedberg K, Shi H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364(1):11–21. CrossRef
- Briggs A, Sculpher M. An introduction to Markov modelling for economic evaluation. PharmacoEconomics. 1998;13:397–409. CrossRef
- National GRIM books. Australian Institute of Health and Welfare. http://www.aihw.gov.au/national-grim-books/ Accessed Feb 2013.
- Ford E, Adams J, Graves N. Development of an economic model to assess the cost-effectiveness of hawthorn extract as an adjunct treatment for heart failure in Australia. BMJ Open. 2012;2(5):pii:e001094.
- Yao G, Freemantle N, Calvert MJ, Bryan S, Daubert JC, Cleland JG. The long-term cost-effectiveness of cardiac resynchronization therapy with or without an implantable cardioverter-defibrillator. Eur Heart J. 2007;28(1):42–51. CrossRef
- Department of Health and Ageing. AR-DRG version 6.0. Canberra: Australian government; 2012. http://www.health.gov.au/internet/main/publishing.nsf/Content/AR-DRG-Version_6.0. Cited 31 Aug 12.
- Data collections. Public Sector Estimated Cost Weights Round 11 AR-DRG v5.1 (Excel 277 KB). http://www.healthemergency.gov.au/internet/main/publishing.nsf/Content/Round_11-cost-reports. Accessed 18 April 2013.
- Australian Institute of Health and Welfare. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442473791. Accessed June 2013
- Pharmaceutical Benefit Scheme (PBS). http://www.pbs.gov.au/pbs/home. Accessed 07 July 2013.
- Medicare Australia. http://www.mbsonline.gov.au/. Accessed 11 Dec 2013.
- Severens JL, Milne RJ. Discounting health outcomes in economic evaluation: the ongoing debate. Value Health. 2004;7:397–401. CrossRef
- Briggs A, Sculpher M, Buxton M. Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. Health Econ. 1994;3:95–104. CrossRef
- O’Hagan A, McCabe C, Akehurst R, Brennan A, Briggs A, Claxton K, et al. Incorporation of Uncertainty in Health Economic Modelling Studies. PharmacoEconomics. 2005;23:529–36. CrossRef
- Kirchmann K, Kirchmann M, Ademi Z, Stoelwinder J. Predictors of successfully listing on the PBS: a 2012 update. Poster presentation. ISPOR 5th Asia-Pacific conference, Taipei; 2012.
- Croom KF, Plosker GL. Eplerenone: a pharmacoeconomic review of its use in patients with post-myocardial infarction heart failure. Pharmacoeconomics. 2005;23(10):1057–72. CrossRef
- de Pouvourville G, Solesse A, Beillat M. Cost-effectiveness analysis of aldosterone blockade with eplerenone in patients with heart failure after acute myocardial infarction in the French context: the EPHESUS study. Arch Cardiovasc Dis. 2008;101(9):515–21. CrossRef
- McKenna C, Burch J, Suekarran S, Walker S, Bakhai A, Witte K, et al. A systematic review and economic evaluation of the clinical effectiveness and cost-effectiveness of aldosterone antagonists for postmyocardial infarction heart failure. Health Technol Assess. 2010;14(24):1–162.
- McKenna C, Walker S, Lorgelly P, Fenwick E, Burch J, Suekarran S, et al. Cost-effectiveness of aldosterone antagonists for the treatment of post-myocardial infarction heart failure. Value Health. 2012;15(3):420–8. CrossRef
- Szucs TD, Holm MV, Schwenkglenks M, Zhang Z, Weintraub WS, Burnier M, et al. Cost-effectiveness of eplerenone in patients with left ventricular dysfunction after myocardial infarction—an analysis of the EPHESUS study from a Swiss perspective. Cardiovasc Drugs Ther. 2006;20(3):193–204. CrossRef
- Weintraub WS, Zhang Z, Mahoney EM, Kolm P, Spertus JA, Caro J, et al. Cost-effectiveness of eplerenone compared with placebo in patients with myocardial infarction complicated by left ventricular dysfunction and heart failure. Circulation. 2005;111(9):1106–13. CrossRef
- Zhang Z, Mahoney EM, Kolm P, Spertus J, Caro J, Willke R, et al. Cost effectiveness of eplerenone in patients with heart failure after acute myocardial infarction who were taking both ACE inhibitors and beta-blockers: subanalysis of the EPHESUS. Am J Cardiovasc Drugs. 2010;10(1):55–63. CrossRef
- Chatterjee S, Moeller C, Shah N, Bolorunduro O, Lichstein E, Moskovits N, et al. Eplerenone is not superior to older and less expensive aldosterone antagonists. Am J Med. 2012;125(8):817–25. CrossRef
- Wang OJ, Krumholz HM. Clinical trial participation: are we studying the patients we are trying to treat? Eur J Heart Failure. 2009;11(11):1021–2. CrossRef
- Krum H, Driscoll A. Management of heart failure. Med J Aust. 2013;199(5):334–9. CrossRef
- Elliott R, Shinogle J, Peele P, Bhosle M, Hughes D. Understanding medication compliance and persistence from an economics perspective. Value Health. 2008;11(4):600–10. CrossRef
- Ryan A. Medication compliance and older people: a review of the literature. Int J Nurs Stud. 1999;36(2):153–62. CrossRef
- Cost Effectiveness of Eplerenone in Patients with Chronic Heart Failure
American Journal of Cardiovascular Drugs
Volume 14, Issue 3 , pp 209-216
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- Author Affiliations
- 1. Department of Medicine (Royal Melbourne Hospital), Melbourne EpiCentre, University of Melbourne, 7 East, Main Building, Grattan Street, Parkville, VIC, 3050, Australia
- 2. Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education (CCRE) in Therapeutics, Monash University, Melbourne, Australia