title: Cost-effectiveness of eplerenone in patients with systolic heart failure and mild symptoms.
abstract: OBJECTIVE
  In the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF), aldosterone blockade with eplerenone decreased mortality and hospitalisation in patients with mild symptoms (New York Heart Association class II) and chronic systolic heart failure (HF). The present study evaluated the cost-effectiveness of eplerenone in the treatment of these patients in the UK and Spain.
  
  
  RESULTS
  Results from the EMPHASIS-HF trial were used to develop a discrete-event simulation model estimating lifetime direct costs and effects (life years and quality-adjusted life years (QALYs) gained) of the addition of eplerenone to standard care among patients with chronic systolic HF and mild symptoms. Eplerenone plus standard care compared with standard care alone increased lifetime direct costs per patient by £4284 for the UK and €7358 for Spain, with additional quality-adjusted life expectancy of 1.22 QALYs for the UK and 1.33 QALYs for Spain. Mean lifetime costs were £3520 per QALY in the UK and €5532 per QALY in Spain. Probabilistic sensitivity analysis suggested a 100% likelihood of eplerenone being regarded as cost-effective at a willingness-to-pay threshold of £20 000 per QALY (UK) or €30 000 per QALY (Spain).
  
  
  CONCLUSIONS
  By currently accepted standards of value for money, the addition of eplerenone to optimal medical therapy for patients with chronic systolic HF and mild symptoms is likely to be cost-effective.
authors.affiliation: BresMed, Sheffield, UK.
authors.forename: Dawn
authors.initials: D
authors.lastname: Lee
authors.affiliation: Health Economic and Outcomes Research, Pfizer Ltd, Surrey, UK.
authors.forename: Koo
authors.initials: K
authors.lastname: Wilson
authors.affiliation: BresMed, Sheffield, UK.
authors.forename: Ron
authors.initials: R
authors.lastname: Akehurst
authors.affiliation: National Heart and Lung Institute, Imperial College (Royal Brompton Hospital) London, London, UK.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Cowie
authors.affiliation: CHU and Department of Cardiology, Inserm, Centre d'Investigation Clinique CIC 9501 and U961, Nancy University, Nancy, France.
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.affiliation: Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia.
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
authors.affiliation: Department of Cardiology, Thorax Centre, University Medical Centre, Groningen, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.affiliation: Pfizer, Inc., New York, USA.
authors.forename: John
authors.initials: J
authors.lastname: Vincent
authors.affiliation: University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.affiliation: The British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D016527:Drug Costs / Q000706:statistics & numerical data; D000077545:Eplerenone; D005102:Health Expenditures / Q000706:statistics & numerical data*; D054143:Heart Failure, Systolic / Q000188:drug therapy / Q000191:economics* / Q000503:physiopathology; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage / Q000191:economics*; D016544:Patient Simulation; D011788:Quality of Life; D012720:Severity of Illness Index; D013030:Spain; D013148:Spironolactone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D006113:United Kingdom; D016277:Ventricular Function, Left
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000077545:Eplerenone
keywords: Heart Failure