TY - JOUR
T1 - Cost-effectiveness of aldosterone antagonists for the treatment of post-myocardial infarction heart failure
AU - McKenna, Claire
AU - Walker, Simon Mark
AU - Lorgelly, Paula
AU - Fenwick, Elisabeth
AU - Burch, Jane Alison
AU - Suekarran, Sara Anita
AU - Bakhai, Ameet
AU - Witte, Klaus
AU - Harden, Melissa
AU - Wright, Kath
AU - Woolacott, Nerys Frances
AU - Palmer, Stephen John
PY - 2012/5
Y1 - 2012/5
N2 - 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 (sic)4457 and (sic)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.
AB - 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 (sic)4457 and (sic)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.
UR - http://www.scopus.com/inward/record.url?scp=84861150674&partnerID=8YFLogxK
U2 - 10.1016/j.jval.2012.01.004
DO - 10.1016/j.jval.2012.01.004
M3 - Article
SN - 1098-3015
VL - 15
SP - 420
EP - 428
JO - Value in Health
JF - Value in Health
IS - 3
ER -