Cost-effectiveness of therapy with a selective aldosterone antagonist eplerenone in patients with heart failure

Objective. To assess cost-effectiveness of selective aldosterone antagonist eplerenone in patients with chronic heart failure (CHF), including those with prior myocardial infarction. Design and methods. Markov modeling was performed on the basis of the results of multicenter clinical trials EMPHASIS and EPHESUS. Cost analysis was performed on the basis of obligatory medical insurance foundation tariffs in St Petersburg in 2011 year. Results. Eplerenone therapy preserved 17 lives per 1000 patients during 6 months in patients with CHF after myocardial infarction (EF ≤ 40 %) and 24 lives in patients with EF ≤ 30 %. The additional cost per patient is only 15,100-15,200 rubles for 6 months. For patients aged 70 years with CHF FC II, receiving eplerenone therapy, the ratio of cost/effectiveness is 360,800 rubles for one additional year lived. Conclusions. Eplerenone therapy is economically feasible in patients with prior myocardial infarction and left ventricular systolic dysfunction. Maximum effectiveness of eplerenone was found in an early phase of myocardial infarction and in patients with ejection fraction ≤ 30 %. These data prove that the inclusion of eplerenone in the list of the medications used in the state system of drug supply, as well as standards of the medical care is possible and highly required.