Key result
Finerenone achieves lifetime U.S. cost-effectiveness at ~$54,000/QALY despite falling short over 32 months.
Why the study?
Finerenone reduced worsening heart failure events and cardiovascular death in FINEARTS-HF, but its cost-effectiveness in patients with HFmrEF/HFpEF remained unknown.
Is finerenone cost-effective compared to standard care in patients with HFmrEF/HFpEF in the US and Germany?
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.
Pricing and horizon determine finerenone value in HF; leaves open real-world adoption thresholds.
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 <5% probability of cost-effectiveness at $100,000 per QALY. Under German pricing, the corresponding ICER was €47,800 per QALY, with cost-effectiveness probabilities of 41% at €30,000 and 63% at €50,000 per QALY. Over a lifetime horizon, finerenone increased discounted QALYs (7.44 vs. 6.98). Lifetime ICERs were $54,000 per QALY in the US and cost-saving in Germany, 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).
No takes yet. Share an insight, caveat, or question.
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).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: