title: Cost-effectiveness of aldosterone antagonists for the treatment of post-myocardial infarction heart failure.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Eplerenone appears more cost-effective than spironolactone for the treatment of post-MI HF. These findings, however, remain subject to important uncertainties regarding the effects of treatment on major clinical events. An adequately powered, well-conducted randomized controlled trial that directly compares spironolactone and eplerenone may be required to provide more robust evidence on the optimal management of post-MI HF. Despite these uncertainties, the use of an aldosterone antagonist was consistently demonstrated to be a highly cost-effective strategy for the management of post-MI HF in the National Health Service.
authors.affiliation: Centre for Health Economics, University of York, York, UK. claire.mckenna@york.ac.uk
authors.forename: Claire
authors.initials: C
authors.lastname: McKenna
authors.forename: Simon
authors.initials: S
authors.lastname: Walker
authors.forename: Paula
authors.initials: P
authors.lastname: Lorgelly
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Fenwick
authors.forename: Jane
authors.initials: J
authors.lastname: Burch
authors.forename: Sara
authors.initials: S
authors.lastname: Suekarran
authors.forename: Ameet
authors.initials: A
authors.lastname: Bakhai
authors.forename: Klaus
authors.initials: K
authors.lastname: Witte
authors.forename: Melissa
authors.initials: M
authors.lastname: Harden
authors.forename: Kath
authors.initials: K
authors.lastname: Wright
authors.forename: Nerys
authors.initials: N
authors.lastname: Woolacott
authors.forename: Stephen
authors.initials: S
authors.lastname: Palmer
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000191:economics* / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000150:complications*
chemical_list: D000451:Mineralocorticoid Receptor Antagonists