The Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) showed that addition of eplerenone to optimal medical therapy reduced morbidity and mortality in patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure. This international study also showed that the addition of eplerenone reduced the number and duration of rehospitalisations for heart failure. A budget impact model has been developed to estimate the effect of adding eplerenone to standard care in the UK. The model is based on the results of the EPHESUS study, UK epidemiological data, UK drug acquisition costs and National Health Service (NHS) hospital in-patient costs and average length of stay for England. All costs are expressed in pounds sterling.
It estimates the incremental costs and benefits of adding eplerenone to standard care in heart failure resulting from myocardial infarction, from the perspective of NHS healthcare decision makers over a three-year period.
The model shows that if all eligible patients are treated with eplerenone the estimated cost per life year saved is £6,730 in year three. In a primary care trust with a population of 250,000, this level of treatment results in a reduction of 46 bed days for rehospitalisations due to heart failure, at a cost per bed day avoided of £1,469. With hospital in-patient care the biggest single healthcare cost in heart failure, reduction in hospitalisation is a key priority within the NHS in the UK. Models such as the one described here enable the budgetary consequences of using a new drug to be identified and clarify the role of drug treatment in delivering NHS priorities.