PMID- 27149456
OWN - NLM
STAT- MEDLINE
DCOM- 20170201
LR  - 20210109
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 95
IP  - 18
DP  - 2016 May
TI  - Cost-Effectiveness of Eplerenone Compared to Usual Care in Patients With Chronic 
      Heart Failure and NYHA Class II Symptoms, an Australian Perspective.
PG  - e3531
LID - 10.1097/MD.0000000000003531 [doi]
LID - e3531
AB  - The objective of this study was to determine the cost-effectiveness of eplerenone 
      compared with usual care in patients with chronic heart failure and New York 
      Heart Association (NYHA) Class II symptoms.A Markov model was constructed with 5 
      health states to reflect NYHA symptom status (Classes I-IV) and death. All 
      subjects began in the "Class II" health state and then moved to other symptom 
      health states or died. Subjects could also be hospitalized for HF in any cycle. 
      Transition probabilities were derived from the Eplerenone in Mild Patients 
      Hospitalization And Survival Study in Heart Failure (EMPHASIS-HF) study. Decision 
      analysis was applied to compare an Eplerenone Group with a Usual Care Group 
      (UCG). In the UCG, 47.3% of subjects in Class II and 93.7% of subjects in Classes 
      III and IV were assumed to be taking spironolactone (as per published data). In 
      the Eplerenone Group, all subjects in Classes II, III, and IV were assumed to be 
      taking eplerenone. The efficacy of spironolactone was assumed to be the same as 
      eplerenone. Cost and utility data were derived from published sources. A discount 
      rate of 5.0% was applied to future costs and benefits. The outcome of interest 
      was incremental cost-effectiveness ratio (ICER) (cost per year of live saved 
      (YoLS) and quality-adjusted life years (QALY) gained).Over 10 years the model 
      predicted that for each patient compared with usual care, eplerenone would lead 
      to 0.26 YoLS (discounted) and 0.19 QALYs gained (discounted), at a net cost of 
      AUD $6961 (discounted). These equate to ICERs of AUD 28,001 per YoLS and AUD 
      37,452 per QALY gained. Sensitivity analyses indicated a 99.0% likelihood of 
      eplerenone being cost-effective compared with usual care at a willingness to pay 
      threshold of AUD 50,000 per QALY gained.From an Australian healthcare 
      perspective, the addition of eplerenone in management of patients with chronic 
      heart failure and NYHA Class II symptoms represents a cost-effective strategy 
      compared with usual care.
FAU - Ademi, Zanfina
AU  - Ademi Z
AD  - From the Department of Epidemiology and Preventive Medicine (DEPM), Monash 
      University, Melbourne, Australia (ZA, DL), Institute of Pharmaceutical Medicine, 
      University of Basel, Basel, Switzerland (ZA), and Optum (KP), Sydney, Australia.
FAU - Pasupathi, Kumar
AU  - Pasupathi K
FAU - Liew, Danny
AU  - Liew D
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Mineralocorticoid Receptor Antagonists)
RN  - 27O7W4T232 (Spironolactone)
RN  - 6995V82D0B (Eplerenone)
SB  - IM
MH  - Australia/epidemiology
MH  - Chronic Disease
MH  - Cost-Benefit Analysis
MH  - Eplerenone
MH  - Heart Failure/economics/epidemiology/therapy
MH  - Hospitalization/statistics & numerical data
MH  - Humans
MH  - Medication Therapy Management/economics/statistics & numerical data
MH  - Mineralocorticoid Receptor Antagonists/economics/therapeutic use
MH  - Severity of Illness Index
MH  - Spironolactone/*analogs & derivatives/economics/therapeutic use
MH  - Survival Analysis
PMC - PMC4863773
COIS- The authors have no conflicts of interest to disclose.
EDAT- 2016/05/07 06:00
MHDA- 2017/02/02 06:00
PMCR- 2016/05/06
CRDT- 2016/05/06 06:00
PHST- 2016/05/06 06:00 [entrez]
PHST- 2016/05/07 06:00 [pubmed]
PHST- 2017/02/02 06:00 [medline]
PHST- 2016/05/06 00:00 [pmc-release]
AID - 00005792-201605030-00021 [pii]
AID - 10.1097/MD.0000000000003531 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2016 May;95(18):e3531. doi: 10.1097/MD.0000000000003531.