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Análisis coste-efectividad de eplerenona en pacientes con insuficiencia cardiaca post-infarto agudo de miocardio

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PharmacoEconomics Spanish Research Articles

Resumen

Objetivo:Eplerenona disminuye la mortalidad y reduce las hospitalizaciones en pacientes con insuficiencia cardiaca tras infarto agudo de miocardio (IAM). El objetivo del estudio fue determinar el coste-efectividad de incorporar eplerenona a la terapia médica estándar (TE) en el tratamiento de la insuficiencia cardiaca post-IAM, desde la perspectiva del Sistema Nacional de Salud español.

Métodos: Se analizó la relación coste-efectividad de eplerenona con TE frente a TE en términos de años de vida ganados (AVG) y años de vida ganados ajustados por calidad (AVAC). Los datos de eficacia se obtuvieron de los 16 meses de seguimiento medio del estudio EPHESUS. La supervivencia se estimó a partir de la base de datos epidemiológica Framingham. Los costes unitarios se obtuvieron de una base de datos sanitaria española (€ de 2008). Sólo se consideraron costes médicos directos. Se aplicó una tasa de descuento anual del 3% a costes y a resultados en salud. Se realizó un análisis de sensibilidad considerando los AVG a partir de las bases de datos epidemiológicas Saskatchewan y Worcester.

Resultados: El número de AVG con eplerenona fue de 0,1014 frente a TE. El coste total fue 660 € superior con eplerenona debido principalmente al coste de adquisición del fármaco (744 €). La relación coste-efectividad incremental de eplerenona frente a TE fue de 6.506 €/AVG y 9.759 €/AVAC. El análisis de sensibilidad confirmó la robustez de los resultados (10.374 €/AVG con Saskatchewan y 4.933€/AVG con Worcester).

Conclusiones: El empleo de eplerenona incorporada a la terapia estándar en pacientes con insuficiencia cardiaca secundaria a IAM es una terapia eficiente en España.

Abstract

Objective: Eplerenone reduces mortality and hospitalizations in patients with heart failure secondary to acute myocardial infarction (AMI). The aim of this study was to assess the cost-effectiveness of adding eplerenone to standard treatment (ST) for post-AMI heart failure from a Spanish Health National System perspective.

Methods: The incremental cost-effectiveness ratio of eplerenone versus ST was assessed by means of the life years gained (LYG) and quality-adjusted life years (QALY) gained. Efficacy data were obtained from the average follow-up period of 16 months in EPHESUS study. Survival estimates were based on the Framingham epidemiologic database. Unitary costs (€ 2008) were obtained from a Spanish cost database. Only direct medical costs were considered. A 3% annual discount rate was applied to cost and health benefits. Deterministic sensitivity analyses were performed based on LYG obtained from Saskatchewan and Worcester databases.

Results: Eplerenone versus ST yields 0.1014 LYG. Total cost with eplerenona was 660 € higher due to pharmacological cost (744 €). Incremental cost-effectiveness ratio of eplerenone versus ST was 6.506 €/LYG and 9.759 €/QALY. Robustness of results was confirmed by the sensitivity analyses (10.374 €/LYG with Saskatchewan and 4.933 €/LYG with Worcester).

Conclusions: The addition of eplerenone to ST in patients with heart failure secondary to AMI is an efficient therapy in Spain.

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Authors and Affiliations

  1. Hospital La Paz, Madrid, España

    Jose L. López-Sendón

  2. Hospital Ramón y Cajal, Madrid, España

    David Martí-Sánchez

  3. Pfizer, España

    Belén Martí

  4. Pharmacoeconomics & Outcomes Research Iberia., C/ Segundo Mata, 1, 28224, Pozuelo de Alarcón, España

    Itziar Oyagüez & Miguel Ángel Casado

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  1. Jose L. López-Sendón
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  2. David Martí-Sánchez
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Correspondence to Itziar Oyagüez.

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López-Sendón, J.L., Martí-Sánchez, D., Martí, B. et al. Análisis coste-efectividad de eplerenona en pacientes con insuficiencia cardiaca post-infarto agudo de miocardio. Pharmacoecon. Span. Res. Artic. 8, 39–50 (2011). https://doi.org/10.1007/BF03320887

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