Cost-Effectiveness of Mineralocorticoid Receptor Antagonists in Heart Failure With Reduced Ejection Fraction: The Brazilian Case With Bayesian Networks and Markov Influence Diagrams
Author(s)
Cristiane Koeche, MSc1, Mariana Pfitzner, PhD1, Adriana Guimarães, MSc, PhD, MD2, MARTA D. FERNANDEZ, MSc3, Yasmim Botelho, Medical student1, Alexandre Magno, Medical student1, Renata R. Moura, Medical student1, Verônica Carvalho, Medical student4, Francisca J. Souza, Medical student1, Vivian C. Batista, PharmD MSc5, Elizabeth Bilevicius, MD MSc PhD5, Andrei Sposito, MSc, PhD, MD6, Ana Claudia Cavalcante Nogueira, MSc, PhD, MD1, Luiz Sérgio F. de Carvalho, MD, MSc, PhD7;
1Catholic University of Brasilia, Brasília, Brazil, 2School of Health Sciences - ESCS, Brasília, Brazil, 3Clarity Healthcare Intelligence, Campinas, Brazil, 4University of Brasilia, Brasília, Brazil, 5Viatris, São Paulo, Brazil, 6State University of Campinas, Campinas, Brazil, 7Catholic University of Brasilia, Full Professor, Brasília, Brazil
1Catholic University of Brasilia, Brasília, Brazil, 2School of Health Sciences - ESCS, Brasília, Brazil, 3Clarity Healthcare Intelligence, Campinas, Brazil, 4University of Brasilia, Brasília, Brazil, 5Viatris, São Paulo, Brazil, 6State University of Campinas, Campinas, Brazil, 7Catholic University of Brasilia, Full Professor, Brasília, Brazil
OBJECTIVES: This study addresses the lack of cost-effectiveness analyses (CEA) on mineralocorticoid receptor antagonists (MRAs) in patients with ischemic and non-ischemic heart failure with reduced ejection fraction (HFrEF). The objectives are to evaluate the cost-effectiveness of MRAs among individuals with HFrEF in the context of the Brazilian public healthcare system (SUS), leveraging data from a real-world Brazilian cohort and an updated systematic review and network meta-analysis (SR/NMA).
METHODS: We employed a Bayesian Network and Markov Influence Diagrams to estimate the incremental cost-effectiveness ratios (ICERs) in international dollars (Int$) per quality-adjusted life year (QALY). Our model was fed by a SR/NMA to compare MRAs effectiveness and used data from a cohort of 1,066 Brazilian individuals with HFrEF (36% with ischemic and 64% with non-ischemic disease). Cost assessments were performed from the perspective of the Brazilian public healthcare system, with values converted to Int$.
RESULTS: Over a 10-year time horizon, the treatment with spironolactone, eplerenone and finerenone compared to no MRA utilization yielded discounted QALY per person of 0.072, 0.111 and 0.034, respectively. The ICERs were Int$7,955, Int$6,460 and Int$109,840 per QALY gained, respectively. Compared to spironolactone, eplerenone showed an ICER of Int$6,178 per QALY gained. Assuming a willingness-to-pay threshold of one Brazilian per capita GDP (Int$17,589) per QALY gained, the probabilistic sensitivity analyses suggest that spironolactone and eplerenone were cost-effective, respectively, in 87% and 92% of iterations. The 95% confidence intervals were Int$2,282 to Int$13,149 for spironolactone and Int$1,795 to Int$12,351 for eplerenone per QALY gained. These findings were consistent across 20 different scenarios including ischemic/non-ischemic HF.
CONCLUSIONS: Our results indicate that both spironolactone and eplerenone have a high probability (>85%) of being cost-effective compared to no MRA use within the Brazilian SUS. Additionally, eplerenone demonstrates a substantial probability of being cost-effective relative to spironolactone in a model population with both ischemic and non-ischemic HFrEF.
METHODS: We employed a Bayesian Network and Markov Influence Diagrams to estimate the incremental cost-effectiveness ratios (ICERs) in international dollars (Int$) per quality-adjusted life year (QALY). Our model was fed by a SR/NMA to compare MRAs effectiveness and used data from a cohort of 1,066 Brazilian individuals with HFrEF (36% with ischemic and 64% with non-ischemic disease). Cost assessments were performed from the perspective of the Brazilian public healthcare system, with values converted to Int$.
RESULTS: Over a 10-year time horizon, the treatment with spironolactone, eplerenone and finerenone compared to no MRA utilization yielded discounted QALY per person of 0.072, 0.111 and 0.034, respectively. The ICERs were Int$7,955, Int$6,460 and Int$109,840 per QALY gained, respectively. Compared to spironolactone, eplerenone showed an ICER of Int$6,178 per QALY gained. Assuming a willingness-to-pay threshold of one Brazilian per capita GDP (Int$17,589) per QALY gained, the probabilistic sensitivity analyses suggest that spironolactone and eplerenone were cost-effective, respectively, in 87% and 92% of iterations. The 95% confidence intervals were Int$2,282 to Int$13,149 for spironolactone and Int$1,795 to Int$12,351 for eplerenone per QALY gained. These findings were consistent across 20 different scenarios including ischemic/non-ischemic HF.
CONCLUSIONS: Our results indicate that both spironolactone and eplerenone have a high probability (>85%) of being cost-effective compared to no MRA use within the Brazilian SUS. Additionally, eplerenone demonstrates a substantial probability of being cost-effective relative to spironolactone in a model population with both ischemic and non-ischemic HFrEF.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE170
Topic
Economic Evaluation
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)