Finerenone was not cost-effective over 32 months at U.S. pricing (ICER $473,000/QALY) but was cost-effective over a lifetime horizon in the U.S. ($54,000/QALY) and Germany (cost-saving).
Is finerenone cost-effective compared to standard care in patients with HFmrEF/HFpEF in the US and Germany?
Finerenone is highly cost-effective over a lifetime horizon for patients with HFmrEF/HFpEF in both the US and Germany, despite not being cost-effective over the shorter 32-month trial horizon at US pricing.
BACKGROUND: In the FINEARTS-HF trial, finerenone reduced total worsening heart failure (WHF) events and cardiovascular death in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). The cost-effectiveness of finerenone in this population remains unknown. AIMS: To assess the cost-effectiveness of finerenone in HFmrEF/HFpEF and the influence of analytic time horizon in the United States and Germany. METHODS: Using FINEARTS-HF data (N = 6, 001), a cohort-based Markov model evaluated in-trial (32-month) and lifetime cost-effectiveness. Trial-derived event rates informed WHF events and mortality, with long-term survival extrapolated using calibrated life tables. Quality-adjusted life-years (QALYs) were estimated from Kansas City Cardiomyopathy Questionnaire scores. Analyses adopted a U. S. health care sector perspective and a European payer context using German statutory health insurance (GKV) costs. Deterministic and probabilistic sensitivity analysis (PSA) were performed. RESULTS: Over 32 months, finerenone increased QALYs from 1. 874 to 1. 911. In the United States (US), the in-trial incremental cost-effectiveness ratio (ICER) was 473, 000 per QALY, with 95% probability of cost-effectiveness. CONCLUSIONS: In patients with HFmrEF/HFpEF, finerenone was not cost-effective over the trial horizon at U. S. pricing but demonstrated favourable economic value under German pricing. Lifetime analyses indicate cost-effectiveness across healthcare systems, consistent with the long-term clinical benefits observed in the trial (FINEARTS-HF; NCT04435626).
Boettger et al. (2026) studied Heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) (n=6,001). Finerenone was evaluated on Incremental cost-effectiveness ratio (ICER). Finerenone was not cost-effective over 32 months at U.S. pricing (ICER $473,000/QALY) but was cost-effective over a lifetime horizon in the U.S. ($54,000/QALY) and Germany (cost-saving).