title: Cost-effectiveness of eplerenone in NYHA class II chronic heart failure patients with reduced LVEF: an analysis for Greece.
abstract: OBJECTIVE
  The aim of the study was to evaluate the cost-effectiveness (CE) of treatment with eplerenone versus standard care in adult patients with New York Heart Association class II chronic heart failure and reduced left ventricular ejection fraction from the perspective of the Greek national health care payer.
  
  
  METHODS
  A discrete-event model simulating the clinical course and respective outcomes of eplerenone as an add-on to standard therapy versus standard therapy alone based on the pivotal Eplerenone in Mild Patients Hospitalization and SurvIval Study in Heart Failure (EMPHASIS-HF) trial was locally adapted for the Greek setting. Data on medications followed the resource use from eplerenone in mild patients hospitalization and survival study in heart failure and were estimated on a lifetime basis (or until discontinuation). Cost calculations were based on year 2014, event costs (cardiovascular hospitalizations, adverse events, and devices) were sourced from published diagnosis-related groups. A 3% discount rate was applied. In order to test the robustness of the model projections, a range of deterministic and probabilistic sensitivity analyses were carried out.
  
  
  RESULTS
  Over a patient's lifetime, the addition of eplerenone to standard care compared to standard care alone led to an incremental gain of 1.33 quality-adjusted life-years (QALYs) (6.53 vs 5.20 QALYs, respectively) as well as an increase in the cost of treatment by €2,160; these outcomes produced an incremental CE ratio of €1,624/QALY for the Greek setting. On the basis of probabilistic sensitivity analysis, there was a 100% likelihood of eplerenone being cost-effective versus standard care at a threshold of €3,500/QALY.
  
  
  CONCLUSIONS
  This analysis indicates that eplerenone may be a cost-effective option versus standard care accompanied by additional clinical benefits and an added incremental cost at an acceptable, if not low, CE ratio. The results are consistent with the previously published studies on the CE of eplerenone as an add-on therapy to standard care, such as those regarding the health care settings of Spain, the UK, and Australia.
authors: Department of Health Economics, National School of Public Health, Athens, Greece.
authors: Kostas
authors: K
authors: Athanasakis
authors: Pfizer Hellas, Athens, Greece.
authors: Aikaterini
authors: A
authors: Bilitou
authors: BresMed, Sheffield, UK.
authors: Dawn
authors: D
authors: Lee
authors: Department of Health Economics, National School of Public Health, Athens, Greece.
authors: Eleftheria
authors: E
authors: Karampli
authors: Department of Cardiology, G. Gennimatas Hospital, Athens, Greece.
authors: Apostolos
authors: A
authors: Karavidas
authors: Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece.
authors: John
authors: J
authors: Parissis
authors: Pfizer Hellas, Athens, Greece.
authors: Georgia
authors: G
authors: Sykara
authors: Department of Health Economics, National School of Public Health, Athens, Greece.
authors: John
authors: J
authors: Kyriopoulos
keywords: EMPHASIS-HF; Greece; cost-effectiveness; eplerenone; heart failure