***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study compared the efficacy and tolerability of eplerenone and enalapril in 499 patients with stage 1 or 2 hypertension who were r and omized to receive eplerenone or enalapril for 6 months in a 3-step titration-to-effect study . After 6 months , patients whose diastolic blood pressure ( BP ) was < 90 mm Hg had their dosages down-titrated were followed for an additional 6 months . Diastolic BP was the primary end point . Eplerenone was as effective as enalapril in reducing both systolic BP  ( eplerenone , -14.5 mm Hg ; enalapril , -12.7 mm Hg ; p = 0.199 ) and diastolic BP ( eplerenone , -11.2 mm Hg ; enalapril , -11.3 mm Hg ; p = 0.910 ) at 6 months . BP reductions at 12 months were also similar between groups ( -16.5/-13.3 mm Hg for eplerenone , -14.8/-14.1 mm Hg for enalapril ; p = 0.251 and 0.331 , respectively ) . Withdrawal rates for adverse events  ( eplerenone 7.9 % , enalapril 9.3 % at 6 months ) and treatment failures  ( eplerenone 23.3 % , enalapril 22.8 % at 6 months ) were also equivalent . Approximately 2/3 of each group had normal BP with monotherapy treatment at 6 months . BP response was independent of renin levels in the eplerenone group , but not in the enalapril group . Both agents reduced albuminuria in patients who had an elevated value at baseline , with significantly greater improvement in patients treated with eplerenone versus enalapril ( -61.5 % vs -25.7 % ; p = 0.01 ) . Both agents were similarly well tolerated , and there was no increased incidence of any sexual adverse events in the eplerenone group . Patients taking enalapril had a higher rate of cough . Both agents increased serum potassium levels , but < 1 % in each group reported adverse events from hyperkalemia .  Eplerenone was as effective as enalapril as monotherapy in patients with stage 1 or 2 hypertension , was more effective in reducing albuminuria , and was well tolerated for 12 months Background —In the Eplerenone Post-Acute Myocardial Infa rct ion Heart Failure Efficacy and Survival Study ( EPHESUS ) , aldosterone blockade with eplerenone decreased mortality in patients with left ventricular systolic dysfunction and heart failure after acute myocardial infa rct ion . The present study was performed to evaluate the cost-effectiveness of eplerenone compared with placebo in these patients . Methods and Results —A total of 6632 patients with left ventricular systolic dysfunction and heart failure after acute myocardial infa rct ion were r and omized to eplerenone or placebo and followed up for a mean of 16 months . The co primary end points were all-cause mortality and the composite of cardiovascular mortality/cardiovascular hospitalization . The evaluation of re source use included hospitalizations , outpatient services , and medications . Eplerenone was priced at the average wholesale price , $ 3.60 per day . Survival beyond the trial period was estimated from data from the Framingham Heart Study , the Saskatchewan Health data base , and the Worcester Heart Attack Registry . The incremental cost-effectiveness of eplerenone in cost per life-year and quality -adjusted life-year gained compared with placebo was estimated . The number of life-years gained with eplerenone was 0.1014 based on Framingham ( 95 % CI , 0.0306 to 0.1740 ) , 0.0636 with Saskatchewan ( 95 % CI , 0.0229 to 0.1038 ) , and 0.1337 with Worcester ( 95 % CI , 0.0438 to 0.2252 ) data . Cost was $ 1391 higher over the trial period in the eplerenone arm ( 95 % CI , 656 to 2165 ) because of drug cost . The incremental cost-effectiveness ratio was $ 13 718 per life-year gained with Framingham ( 96.7 % under $ 50 000 per life-year gained ) , $ 21 876 with Saskatchewan , and $ 10 402 with Worcester . Conclusions —Eplerenone compared with placebo in the treatment of heart failure after acute myocardial infa rct ion is effective in reducing mortality and is cost-effective in increasing years of life by commonly used criteria BACKGROUND The Eplerenone Post-Acute Myocardial Infa rct ion Heart Failure Efficacy and Survival Study ( EPHESUS ) r and omized clinical trial demonstrated the efficacy of eplerenone , a new aldosterone antagonist diuretic , with st and ard treatment versus st and ard treatment alone in the reduction of cardiovascular mortality and cardiovascular-related hospital readmissions for patients with heart failure after an acute myocardial infa rct ion . AIM We assessed the incremental cost per life-year saved of eplerenone in the French context versus st and ard treatment . METHODS A within-trial study was design ed . A piecewise regression model yielded death rates and survival gains adjusted for patients ' characteristics , based on the extraction of comparable patients from the Saskatchewan Health data base . Re source use was collected alongside the clinical trial data . Only direct medical costs were considered . All costs were in 2003 euros . Costs and outcomes were discounted at 5 % . RESULTS The overall mortality rate was 14.4 % in the treatment group versus 16.7 % in the placebo group ( p=0.008 ) . Combined cardiovascular deaths and hospitalization rates were 26.7 % in the treatment group versus 30.3 % in the placebo group ( p=0.002 ) . The discounted survival gain was 3.2 weeks . The incremental cost per life-year saved was euro15,382 ( 95 % confidence interval 8274 - 42,723 ) . Seventy-four per cent of the values of the incremental cost-effectiveness ratio fell under a euro15,000 per life-year saved threshold . CONCLUSION The cost of eplerenone leads to an acceptable level of incremental cost per life-year saved when compared with existing treatments in the cardiovascular domain for the prevention of cardiovascular death and morbidity in patients with heart failure after an acute myocardial infa rct ion Objective The EPHESUS study demonstrated that aldosterone blockade with eplerenone decreased mortality in patients with left ventricular systolic dysfunction ( LVSD ) and heart failure after acute myocardial infa rct ion ( AMI ) . The EPHESUS pharmacoeconomic analysis was performed to evaluate the cost-effectiveness of eplerenone in the Swiss setting . Material s and methods A total of 6,632 patients with LVSD and heart failure after AMI were r and omized to eplerenone or placebo and followed for a mean of 16 months . The co- primary endpoints were all-cause death and the composite of cardiovascular death/cardiovascular hospitalization . The evaluation of re source use included hospitalizations , outpatient services , and medications . Survival beyond the trial period was estimated using data from the Framingham Heart Study , the Saskatchewan Health data base , and the Worcester Heart Attack Registry . The incremental cost-effectiveness of eplerenone  in cost per life-year and quality -adjusted life-year gained was estimated . The perspective of the Swiss third party payers was used . Daily treatment costs of eplerenone were set at CHF 3.88 . All other re sources were valued on the basis of official tariffs . Discounting of the results was performed at a rate of 3 % . Results The number of life-years gained with eplerenone was 0.1083 based on Framingham , 0.0661 with Saskatchewan and 0.1518 with Worcester survival estimates . Total costs were CHF 1,028 higher over the trial period in the eplerenone arm , due to drug cost . The incremental cost-effectiveness ratio was CHF 10,145 per life-year gained with Framingham , CHF 16,178 with Saskatchewan , and CHF 7,693 with Worcester survival estimates . The corresponding costs per QALY were CHF 15,219 , CHF 23,965 and CHF 11,337 , respectively . Conclusion Eplerenone is effective in reducing mortality and , in Switzerl and , is also cost-effective in increasing years of life for patients with LVSD after AMI 
    Output:
    
Incremental cost-effectiveness ratio was high in the United States compared to European countries .
Conclusions : Based on the results of the studies review ed in the present study , it seems that eplerenone has acceptable costeffectiveness compared with current treatments , placebo , and similar drugs