A systematic review and economic evaluation of the clinical effectiveness and cost-effectiveness of aldosterone antagonists for postmyocardial infarction heart failure

Abstract

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Association of Biomarkers with Serious Cardiac Adverse Events during Abiraterone Acetate Treatment in Castration Resistant Prostate Cancer

“…Thus, we choose canrenone, an analog of aldosterone, which competitively binds to the mineralocorticoid receptors in the distal renal tubules and collector ducts and favors sodium and water elimination while limiting potassium excretion. Canrenone has not been associated with tumor growth [20], is an inexpensive drug, and induced a significant improvement of LVEF in a randomized trial [13], [14], [21]. After switching to dexametasone and introducing canrenone, no additional cardiac SAEs were noted.…”

“…Our different findings may be explained by subtle differences in the patient population in terms of higher cardiovascular risk and prior use of ketoconazole, which was used in two out of five patients who had a cardiac SAE. However, the registration trials indicate that cardiac SAEs were more frequent on abiraterone acetate than placebo [1], [2], [3], [4],17], and EMA has identified prior hypertension, hypokalemia, fluid retention, edema, and cardiac disorders as risk factors for the risk management plan [21].…”

Cost‐Effectiveness Analysis of Sacubitril/Valsartan for the Treatment of Heart Failure with Reduced Ejection Fraction in the United States

“…Ivabradine, approved in the United States in 2015 for HFrEF, is estimated to provide both a cost‐savings and QALY benefit compared with standard of care among the commercially insured, and is cost‐effective ($24,920/QALY gained) among Medicare Advantage patients . Eplerenone, an aldosterone antagonist, has been demonstrated as consistently cost‐effective (ICER < $50,000/QALY gained) compared with standard of care in the post‐myocardial infarction HF population, with some estimates as low as $11,393/QALY gained . Nonpharmacologic therapies such as cardiac resynchronization therapy and implantable cardioverter defibrillators are generally cost‐effective, with ICERs ranging from $20,000 to $90,000/QALY gained .…”

Deriving Input Parameters for Cost-Effectiveness Modeling: Taxonomy of Data Types and Approaches to Their Statistical Synthesis

“…An example of its use within an economic model is the prevention and treatment of influenza A and B [39], where a separate meta-analysis was conducted to evaluate time to symptoms alleviated and time to return to normal activities for different baseline risk groups. In another study, McKenna et al [40] recently carried out a systematic review and economic evaluation of the clinical effectiveness and cost-effectiveness of aldosterone antagonists for post-myocardial infarction heart failure. The authors estimated the effectiveness parameter to inform their cost-effectiveness model by using a Bayesian meta-regression model.…”