Cost-Effectiveness of Mineralocorticoid Receptor Antagonists in Heart Failure With Reduced Ejection Fraction: The Brazilian Case With Bayesian Networks and Markov Influence Diagrams
Moderator
Luiz Sérgio F Carvalho, MSc, PhD, MD, Universidade Católica de Brasília, Brasília, Brazil
Speakers
Cristiane Koeche; Mariana Pfitzner; Adriana Guimarães; MARTA DURAN FERNANDEZ; Yasmim Botelho; Alexandre Magno; Renata Moura; Verônica Carvalho; Francisca Souza; Vivian Cardoso Batista; Elizabeth Bilevicius; Andrei Sposito; Ana Claudia Cavalcante Nogueira
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)