What is the cost-effectiveness of using mineralocorticoid receptor antagonists compared to placebo for heart failure with reduced ejection fraction?
According to the study selection flow chart in Appendix D of Treating Heart Failure Chronic Heart Failure NICE 2018, the incremental cost-effectiveness of mineralocorticoid receptor antagonists versus placebo for heart failure with reduced ejection fraction was estimated using a discrete event simulation model with a lifetime time horizon. The model found eplerenone to be cost-effective, with an incremental cost-effectiveness ratio (ICER) of 20,730 and 20,101 per quality-adjusted life year (QALY) gained. In the two-way sensitivity analysis, spironolactone was found to be more effective and less costly than the placebo cohort. 