[Cost effectiveness of the use of spironolactone in the treatment of chronic heart failure].
BACKGROUND
Chronic heart failure (CHF) is the first cause of hospitalization in elderly patients. The use of spironolactone in patients with CHF (degree III-IV) reduces their mortality and the rate of hospitalization. The aim of this study has been to assess the efficiency of using spironolactone in the treatment of CHF when compared with the use of conventional treatment alone.


METHODS
The study has been performed through the design of a decision analytic model. A cost-effectiveness analysis was carried out by doing a simulation of 2 hypothetic cohorts of 1000 patients with CHF. It was evaluated the costs of each extra life year gained with each alternative under study. Data included have been obtained from Rales and the mean survival time for these patients has been considered of 4.3 years. Only direct medical costs have been included into this analysis. The chosen perspective has been the society and the time horizon included has been of 4.3 years.


RESULTS
The cost/effectiveness ratio has been better in the spironolactone group (1,961,214) than in the standard treatment alone (2,242,912) and each extra life year gained when adding spironolactone to the conventional treatment yielded an additional cost of 591,457 ptas. The sensitivity analysis performed has shown that the option of using spironolactone presents always a better cost/effectiveness ratio even in the worst scenarios.


CONCLUSIONS
The association of 25 mg/day of spironolactone to the conventional treatment of CHF is going to get more life years gained for these patients with a reasonable cost and clearly affordable by our National Health Service.
Soto Alvarez
J
J
Unidad de Farmacoeconomía e Investigación de Resultados en Salud, Departamento de Medicina, Pharmacia S.A. Madrid.
González Vilchez
F
F
D003362:Cost-Benefit Analysis; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000191:economics* / Q000627:therapeutic use*; D013030:Spain; D013148:Spironolactone / Q000191:economics* / Q000627:therapeutic use*; D016019:Survival Analysis
D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone