See also the health economic study selection flow chart in Appendix D. Treating Heart Failure Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: Table 49: Health economic evidence profile: Mineralocorticoid receptor antagonists versus placebo for heart failure with reduced ejection fraction Study Applicability Limitations Other comments Incremental cost Incremental effects Cost- effectiveness Uncertainty (UK) Directly applicable(a) Potentially serious limitations(b) Discrete event simulation model using EMPHASIS-HF RCT trial data. Two comparators: 1. Standard therapy (ACEi and BB) 2. Eplerenone (starting dose of 25mg daily increased to 50mg daily after 4 weeks) in addition to standard therapy. Trial follow-up: 4 years Lifetime time horizon modelled QALY gained Eplerenone remained cost- effective after undertaking both deterministic and probabilistic sensitivity analysis. Two scenario analyses using EMPHASIS-HF data with no extrapolation and another using only a 2 year time horizon generated ICERs of 20,730 and 20,101 per QALY gained, respectively. In all other scenario analyses eplerenone remained cost-effective. Partially applicable(c) Potentially serious limitations(d) Cost effectiveness analysis reporting cost per life year gained Two comparators: 1. Optimal medical management (might include diuretics, ACEi, digoxin, BB, or a combination of these) 2. Spironolactone added to optimal medical management Time horizon: 10 years NR NR 291/ LY gained(e) Two-way sensitivity analysis variation of probabilities of death One-way sensitivity analysis additional outpatient visits required to initiate medication for One-way sensitivity analysis cost of hospitalisation varied ( 663; spironolactone cohort dominates (it is more effective and less costly than) the placebo cohort. Treating Heart Failure Chronic Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. 