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Eplerenone is Cost-Effective for Patients with Heart Failure After a Myocardial Infarction: Presented at ACC
By Jill Stein
NEW ORLEANS, LA -- March 9, 2004 -- New findings indicate that selective aldosterone blockade with eplerenone post-myocardial infarction (MI) in patients with heart failure prevents cardiovascular events and prolongs life at a cost that is acceptable according to standard benchmarks.
Dr. William S. Weintraub, with Emory University in Atlanta, Georgia, reported the data here on March 8th at the American College of Cardiology 53rd Annual Scientific Session. The goal of the study was to determine the cost-effectiveness of eplerenone based on the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS).
The EPHESUS study evaluated the co-primary end points of total mortality and cardiovascular (CV) mortality/CV hospitalization in 6,632 post-MI patients with systolic left ventricular dysfunction and symptoms of heart failure. Treatment involved eplerenone 25 mg titrated to 50 mg QD or placebo in addition to standard therapy and patients were followed for a mean of 16 months.
Results showed that eplerenone reduced total mortality by 15% (P = .008) and cardiovascular mortality/hospitalization by 13% (P = .002).
The analysis aimed to compare the total costs incurred from randomization through the end of follow-up between the eplerenone and placebo treatment arms. Also, if the eplerenone arm was found to be both more costly and more effective than placebo, the investigators then aimed to determine the incremental cost-effectiveness of the addition of eplerenone in the management of heart failure complicating acute MI.
Trial wide efficacy and resource use were assessed. Unit costs in multiple countries were applied to hospitalizations and emergency room visits by diagnosis-related groups and outpatient procedures. Medication use was costed using average wholesale price. Initial hospitalization costs were not included in the base case as the study drug was initiated towards the end of this hospitalization period.
Results showed that there was no significant difference between the treatment groups for the cost in any category of examined healthcare resource use. In fact, the costs of the initial hospitalization, rehospitalization and emergency room visits during follow-up were lower for patients treated with eplerenone, whereas medication costs and outpatient procedure costs during follow-up were higher for eplerenone patients.
The costs of CV rehospitalizations and heart failure rehospitalizations were lower among patients treated with eplerenone versus those treated with placebo. For heart failure reshospitalizations, the difference was statistically significant.
Eplerenone provided a significant advantage over placebo for in-trial life-years (1.33 years for eplerenone and 1.30 years for placebo patients) and for lost life expectancy when life expectancy was calculated using published Framingham data (0.5390 and 0.6404 for the 2 groups, respectively).
Overall, independently of drug costs, aldosterone blockade with eplerenone in the setting of heart failure post-MI is a dominant strategy that can prevent events, prolong life and reduce resource use without increasing cost, Dr. Weintraub said.
[Study title: Cost-Effectiveness of Eplerenone in Patients With Heart Failure Postmyocardial Infarction. Abstract 1108-122]
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