Cost Effectiveness of Eplerenone for the Treatment of Systolic Heart Failure with Mild Symptoms in Alberta, Canada.
BACKGROUND
Eplerenone has been demonstrated as being cost effective for the treatment of patients with systolic heart failure (HF) and mild symptoms in several jurisdictions; however, its cost effectiveness is unknown in the context of Alberta, Canada.


METHODS
We used a discrete-event simulation model to compare costs and outcomes between standard care and standard care plus eplerenone for the treatment of HF with mild symptoms. We used Alberta data (whenever possible) together with a healthcare perspective, a lifetime horizon, and 3 % annual discount rate for analyses.


RESULTS
Clinically, eplerenone prevented HF hospitalizations, atrial fibrillations, and cardiovascular (CV) deaths, but incurred more adverse events and device implantations than standard care. The remaining life of patients receiving eplerenone was 7.08 versus 5.83 years for those receiving standard care. Eplerenone gained 1.25 life-years and 1.18 quality-adjusted life-years (QALYs), with an incremental cost of $Can7200. Therefore, the incremental cost-effectiveness ratio (ICER) was $Can5700 per life-year gained and $Can6100 per QALY gained.


CONCLUSIONS
Given the most cited ICER threshold is $Can50,000, the use of eplerenone as an adjunct to standard care for treating patients with systolic HF and mild symptoms is cost effective in the context of Alberta. Eplerenone would cost the Alberta health system about $Can4.6 million a year in drug costs. Incorporating reductions in health services utilization associated with eplerenone, the budget impact is smaller. For the first year, the use of eplerenone is cost saving and for 5 years the cost is approximately $Can6 million.
Institute of Health Economics, 1200-10405 Jasper Ave, Edmonton, AB, T5J 3N4, Canada. tnguyen@ihe.ca.|School of Public Health, University of Alberta, Edmonton, AB, Canada. tnguyen@ihe.ca.
Nguyen X
NX
Thanh
Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Justin A
JA
Ezekowitz
School of Public Health, University of Alberta, Edmonton, AB, Canada.
Dat T
DT
Tran
Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Padma
P
Kaul
D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D064420:Drug-Related Side Effects and Adverse Reactions / Q000191:economics; D000077545:Eplerenone; D005260:Female; D054143:Heart Failure, Systolic / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D013148:Spironolactone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000077545:Eplerenone