Cost-effectiveness of aldosterone antagonists for the treatment of post-myocardial infarction heart failure

Claire McKenna, Simon Walker, Paula Kate Lorgelly, Elisabeth A L Fenwick, Jane Burch, Sara Suekarran, Ameet Bakhai, Klaus Witte, Melissa Harden, Kath Wright, Nerys Woolacott, Stephen Palmer

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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 4457 and 7893 British pounds 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.
Original languageEnglish
Pages (from-to)420 - 428
Number of pages9
JournalValue in Health
Issue number3
Publication statusPublished - 2012

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