Cost-Effectiveness of Eplerenone Compared With Placebo in Patients With Myocardial Infarction Complicated by Left Ventricular Dysfunction and Heart Failure

Weintraub, William S.; Zhang, Zefeng; Mahoney, Elizabeth M.; Kolm, Paul; Spertus, John A.; Jaime, J.; Ishak, Jack; Goldberg, Robert J.; Tooley, Joseph F.; Willke, Richard J.; Pitt, Bertram

doi:10.1161/01.cir.0000157146.86758.bc

Cited by 66 publications

(42 citation statements)

References 26 publications

(23 reference statements)

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“…17 Briefly, costs from all participating countries were determined by quantifying resource use, applying the US Medicare Fee Schedule, and standardizing costs to US dollars for the year 2001. For inpatient hospitalizations during follow-up, an investigator blinded to patient characteristics and treatment group assigned diagnosis-related groups to each hospitalization.…”

Section: Cost Assessmentmentioning

confidence: 99%

Patient Health Status and Costs in Heart Failure

et al. 2009

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Background-Although a variety of prognostic tools have been shown to predict rehospitalization and mortality in heart failure patients, their utility in assessing future costs is less clear. We assessed whether health status assessment with the Kansas City Cardiomyopathy Questionnaire (KCCQ) predicts future costs in stable heart failure outpatients with left ventricular dysfunction after myocardial infarction. Methods and Results-We evaluated 12-month cost utilization data from 1516 heart failure outpatients enrolled in the Quality-of-Life Substudy of the Eplerenone Post-Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS). Multivariable hierarchical models assessed whether the KCCQ (categorized as 0 to Ͻ25, 25 to Ͻ50, 50 to Ͻ75, and 75 to 100) was an independent predictor of future resource use.

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Section: Cost Assessmentmentioning

confidence: 99%

Patient Health Status and Costs in Heart Failure

et al. 2009

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“…More recently, the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) showed that adding a selective MR antagonist, eplerenone, to optimal medical therapy reduces morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure (6). Based on the results from these two multicenter clinical analyses and other clinical studies (7,8), most national guideline groups now recommended MR antagonists in preference to other antihypertensive agents in hypertensive patients with heart diseases (9 -11). However, recent studies have also indicated the potential roles of aldosterone and MR in the pathogenesis of renal injury.…”

Section: Introductionmentioning

confidence: 99%

Possible Underlying Mechanisms Responsible for Aldosterone and Mineralocorticoid Receptor–Dependent Renal Injury

et al. 2008

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Abstract. There is increasing evidence indicating the roles of aldosterone and mineralocorticoid receptor (MR) in the pathogenesis of renal injury. In rats, chronic treatment with aldosterone and salt results in severe proteinuria and renal tissue injury, characterized by glomerulosclerosis and tubulointerstitial fibrosis. Aldosterone-induced renal tissue injury is associated with increases in reactive oxygen species (ROS) levels and activation of mitogen-activated protein kinases (MAPKs) or Rho-kinase. Treatment with a selective MR antagonist, eplerenone, prevents aldosterone-induced increases in ROS levels and MAPK activity and ameliorates renal injury. In vitro studies have revealed that MR is highly expressed in glomerular mesangial cells (RMCs), podocytes, and renal interstitial fibroblasts. In these renal cells, aldosterone induces cellular injury through NADPH oxidase-dependent ROS production and activation of MAPKs or Rhokinase. Such aldosterone-induced renal cellular injury is markedly attenuated by treatment with eplerenone. These data suggest that aldosterone induces renal injury via activation of MR through mechanisms that cannot be simply explained by changes in blood pressure. In this review, we summarized recent findings on the roles of aldosterone and MR in the pathogenesis of renal injury with particular emphasis on potential underlying mechanisms.

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“…Several cost of illness and cost of care analyses suggest that HF poses a great economic burden to health care providers and society as a whole [8]. HF is the single most frequent cause of hospitalization for people aged 65 and older.…”

Section: Introductionmentioning

confidence: 99%

“…If the same cost-effectiveness endpoints are used (e.g., costs per life-year saved), it is possible to compare treatments across various indications. Although a US economic evaluation of the EPHESUS trial has become available recently [8], it is still required by national Swiss policy makers to obtain cost-effectiveness estimates adapted to the particular situation in Switzerland.…”

Section: Introductionmentioning

confidence: 99%