Cost-effectiveness of spironolactone in patients with severe heart failure.

BACKGROUND: Management of heart failure is estimated to consume between 1% and 2% of total healthcare resources with hospital admissions accounting for up to 70% of this. The ability of the aldosterone antagonist spironolactone to reduce hospital admission rates by 35% would be expected to prove cost-effective.

AIM: To determine the cost-effectiveness of spironolactone when added to standard therapy in patients with severe chronic heart failure.

METHODS: A Markov model of chronic heart failure was constructed using Treeage software. Irish cost data were incorporated into the model.

RESULTS: The incremental cost-effectiveness ratio (ICER) for spironolactone therapy was Euro 466 per life year gained (LYG). Sensitivity analysis demonstrated an ICER range of Euro 75 to Euro 1,136 per LYG.

CONCLUSION: This economic evaluation suggests that the addition of spironolactone to standard therapy for patients with severe chronic heart failure is not only safe and effective, but is highly cost-effective in the Irish healthcare setting.