Cost-effectiveness of eplerenone compared with placebo in patients with myocardial infarction complicated by left ventricular dysfunction and heart failure.
BACKGROUND
In the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS), aldosterone blockade with eplerenone decreased mortality in patients with left ventricular systolic dysfunction and heart failure after acute myocardial infarction. The present study was performed to evaluate the cost-effectiveness of eplerenone compared with placebo in these patients.


RESULTS
A total of 6632 patients with left ventricular systolic dysfunction and heart failure after acute myocardial infarction were randomized to eplerenone or placebo and followed up for a mean of 16 months. The coprimary end points were all-cause mortality and the composite of cardiovascular mortality/cardiovascular hospitalization. The evaluation of resource use included hospitalizations, outpatient services, and medications. Eplerenone was priced at the average wholesale price, 3.60 dollars per day. Survival beyond the trial period was estimated from data from the Framingham Heart Study, the Saskatchewan Health database, and the Worcester Heart Attack Registry. The incremental cost-effectiveness of eplerenone in cost per life-year and quality-adjusted life-year gained compared with placebo was estimated. The number of life-years gained with eplerenone was 0.1014 based on Framingham (95% CI, 0.0306 to 0.1740), 0.0636 with Saskatchewan (95% CI, 0.0229 to 0.1038), and 0.1337 with Worcester (95% CI, 0.0438 to 0.2252) data. Cost was 1391 dollars higher over the trial period in the eplerenone arm (95% CI, 656 to 2165) because of drug cost. The incremental cost-effectiveness ratio was 13,718 dollars per life-year gained with Framingham (96.7% under 50,000 dollars per life-year gained), 21,876 dollars with Saskatchewan, and 10,402 dollars with Worcester.


CONCLUSIONS
Eplerenone compared with placebo in the treatment of heart failure after acute myocardial infarction is effective in reducing mortality and is cost-effective in increasing years of life by commonly used criteria.
Weintraub
William S
WS
Emory University, 1256 Briarcliff Rd, Suite 1N, Atlanta, GA 30306, USA. wweintr@emory.edu
Zhang
Zefeng
Z
Mahoney
Elizabeth M
EM
Kolm
Paul
P
Spertus
John A
JA
Caro
Jaime
J
Ishak
Jack
J
Goldberg
Robert
R
Tooley
Joseph
J
Willke
Richard
R
Pitt
Bertram
B
D000368:Aged; D002423:Cause of Death; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D016527:Drug Costs; D000077545:Eplerenone; D005260:Female; D017048:Health Care Costs; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000150:complications* / Q000191:economics; D019057:Quality-Adjusted Life Years; D013148:Spironolactone / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000191:economics / Q000209:etiology*
D013148:Spironolactone; D000077545:Eplerenone