Centre for Health Economics, University of York, York, UK.
Value Health. 2012 May;15(3):420-8. doi: 10.1016/j.jval.2012.01.004. Epub 2012 Mar 29.
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.
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.
The incremental cost-effectiveness ratio of eplerenone compared with that of standard care alone was £ 4457 and £ 7893 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.
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.
从英国国家医疗服务体系的角度评估依普利酮作为心肌梗死后心力衰竭（HF）患者标准治疗的附加治疗的成本效益，与螺内酯相比。
进行了系统评价，并使用来自随机对照试验的证据，采用贝叶斯荟萃回归方法确定依普利酮和螺内酯的相对疗效。开发了一个决策分析模型，以评估试验主要结局相关的成本和后果，终生时间范围内。
当假设 2 年和终生治疗持续时间时，与单独标准治疗相比，依普利酮的增量成本效益比分别为每额外质量调整生命年 4457 英镑和 7893 英镑。在这两种情况下，与依普利酮相比，螺内酯的成本效益都不明显。结果对荟萃回归中估计的依普利酮与螺内酯的相对疗效较高较为敏感。当假设对死亡率和住院的类效应时，螺内酯成为最具成本效益的治疗方法。
依普利酮在治疗心肌梗死后 HF 方面比螺内酯更具成本效益。然而，这些发现仍然存在关于治疗对主要临床事件影响的重要不确定性。可能需要进行一项充分有力、精心设计的随机对照试验，直接比较螺内酯和依普利酮，以提供关于心肌梗死后 HF 最佳管理的更可靠证据。尽管存在这些不确定性，但在英国国家医疗服务体系中，使用醛固酮拮抗剂始终被证明是治疗心肌梗死后 HF 的一种非常具有成本效益的策略。
